Remedy of Atlas Fractures: Suggestions of the Backbone Part of the German Society for Orthopaedics and Trauma (DGOU).
International Backbone J. 2018 Sep;eight(2 Suppl):5S-11S
Authors: Kandziora F, Scholz M, Pingel A, Schleicher P, Yildiz U, Kluger P, Pumberger M, Korge A, Schnake KJ, Backbone Part of the German Society for Orthopaedics and Trauma
Examine Design: Narrative overview and professional advice.
Targets: To ascertain remedy suggestions for atlas fractures primarily based on the data of the consultants of the Backbone Part of the German Society for Orthopaedics and Trauma.
Strategies: Neither high-level proof research evaluating conservative and operative administration nor research matching completely different operative remedy methods exist. This advice summarizes the data of the consultants of the Backbone Part of the German Society for Orthopaedics and Trauma with regard to the remedy of atlas fractures.
Outcomes: Most atlas fractures are the results of compression forces. A useful morphological classification system has been described by Gehweiler. For an ample prognosis, a computed tomography is obligatory. To tell apart between secure and unstable sort three accidents, it’s obligatory to judge the integrity of the transverse atlantal ligament (TAL) with magnetic resonance imaging and to categorise the TAL lesions. The vast majority of atlas fractures are secure and will probably be efficiently managed conservatively. Unstable atlas fractures (sort 3b and sagittal break up sort four fractures) must be handled by surgical stabilization. Unstable atlas fractures (sort 3b) with a midsubstance ligamentous disruption or severely dislocated ligamentous bony avulsions of the TAL can efficiently be handled by a C1/2 fusion. Unstable atlas fractures (sort 3b) with a reasonably dislocated ligamentous bony avulsion of the TAL and sagittal break up sort four fractures could also be handled by atlas osteosynthesis solely.
Conclusions: Whereas nearly all of atlas fractures might be managed conservatively, in particular fracture patterns surgical remedy methods have turn out to be the usual of care.
PMID: 30210964 [PubMed]