Recommendations for the Diagnostic Testing and Therapy of Atlas Fractures

TY - JOUR

T1 - Recommendations for the Diagnostic Testing and Therapy of Atlas Fractures

AU - Schleicher, Philipp

AU - Scholz, Matti

AU - Kandziora, Frank

AU - Badke, Andreas

AU - Dreimann, Marc

AU - Gebhard, Harry W

AU - Gercek, Erol

AU - Gonschorek, Oliver

AU - Hartensuer, René

AU - Jarvers, Jan-Sven Gilbert

AU - Katscher, Sebastian

AU - Kobbe, Philipp

AU - Koepp, Holger

AU - Matschke, Stefan

AU - Mörk, Sven

AU - Müller, Christian W

AU - Osterhoff, Georg

AU - Pécsi, Ferenc

AU - Pishnamaz, Miguel

AU - Reinhold, Maximilian

AU - Schmeiser, Gregor

AU - Schnake, Klaus John

AU - Schneider, Kristian

AU - Spiegl, Ulrich Josef Albert

AU - Ullrich, Bernhard

N1 - Georg Thieme Verlag KG Stuttgart · New York.

PY - 2019/10

Y1 - 2019/10

N2 - In a consensus process with four sessions in 2017, the working group on "the upper cervical spine" of the German Society for Orthopaedic and Trauma Surgery (DGOU) formulated "Therapeutic Recommendations for the Diagnosis and Treatment of Fractures to the Upper Cervical Spine", incorporating their own experience and current literature. The following article describes the recommendations for the atlas vertebra. About 10% of all cervical spine injuries include the axis vertebra. The diagnostic process primarily aims to detect the injury and to determine joint incongruency and integrity of the atlas ring. For classification purposes, the Gehweiler classification and the Dickman classification are suitable. The Canadian c-spine rule is recommended for clinical screening for c-spine injuries. CT is the preferred imaging modality; MRI is needed to determine the integrity of the Lig. transversum atlantis in complete atlas ring fractures. Conservative treatment is appropriate in very many atlas fractures. Surgical treatment is recommended in existing or potential joint incongruity or instability, which are frequently seen in Gehweiler IIIB or Gehweiler IV fractures. Posterior atlanto-axial stabilisation and fusion using transarticular screws or an internal fixator are regarded as a gold standard in the majority of surgical cases. Especially in young patients, the possibility of isolated atlas osteosynthesis should be checked. A possible option for Gehweiler IV fractures is halo-fixation with mild distraction for ligamentotaxis. Secondary dislocation should be checked for frequently. Involvement of the occipito-atlantal joint complex requires stabilisation of the occiput as well.

AB - In a consensus process with four sessions in 2017, the working group on "the upper cervical spine" of the German Society for Orthopaedic and Trauma Surgery (DGOU) formulated "Therapeutic Recommendations for the Diagnosis and Treatment of Fractures to the Upper Cervical Spine", incorporating their own experience and current literature. The following article describes the recommendations for the atlas vertebra. About 10% of all cervical spine injuries include the axis vertebra. The diagnostic process primarily aims to detect the injury and to determine joint incongruency and integrity of the atlas ring. For classification purposes, the Gehweiler classification and the Dickman classification are suitable. The Canadian c-spine rule is recommended for clinical screening for c-spine injuries. CT is the preferred imaging modality; MRI is needed to determine the integrity of the Lig. transversum atlantis in complete atlas ring fractures. Conservative treatment is appropriate in very many atlas fractures. Surgical treatment is recommended in existing or potential joint incongruity or instability, which are frequently seen in Gehweiler IIIB or Gehweiler IV fractures. Posterior atlanto-axial stabilisation and fusion using transarticular screws or an internal fixator are regarded as a gold standard in the majority of surgical cases. Especially in young patients, the possibility of isolated atlas osteosynthesis should be checked. A possible option for Gehweiler IV fractures is halo-fixation with mild distraction for ligamentotaxis. Secondary dislocation should be checked for frequently. Involvement of the occipito-atlantal joint complex requires stabilisation of the occiput as well.

KW - Canada

KW - Cervical Atlas/diagnostic imaging

KW - Consensus

KW - Conservative Treatment

KW - Fracture Fixation, Internal

KW - Humans

KW - Joint Dislocations/surgery

KW - Multiple Trauma/diagnosis

KW - Orthotic Devices

KW - Spinal Fractures/classification

KW - Spinal Fusion

KW - Vascular System Injuries/complications

U2 - 10.1055/a-0809-5765

DO - 10.1055/a-0809-5765

M3 - SCORING: Journal article

C2 - 30722075

VL - 157

SP - 566

EP - 573

JO - Z ORTHOP UNFALLCHIR

JF - Z ORTHOP UNFALLCHIR

SN - 1864-6697

IS - 5

ER -