Abstract
Purpose
The treatment of C2 fractures with collar, halo or surgery can all be justified depending on the patient. In our unit, primary treatment is with a halo: in a previous study presented at BASS we found an 85% fusion rate. In a follow on study, we wished to assess the outcome in those patients who underwent surgical treatment.
Methods
The discharge logbook was examined retrospectively to identify patients who had posterior instrumentation for C2 fractures from 2008-2010 inclusive. Discharge summaries, clinic letters and radiology images/reports from PACS were analysed to obtain data regarding primary treatment, outcome, necessity for delayed treatment and radiological evidence of union.
Results
Seven patients were identified who had surgery for C2 fracture. All 7 patients were treated with C1 and C2 lateral mass screws. In two of these patients additional lateral mass screws were inserted at C3. Due to patient preference, three of the seven patients underwent operative fixation without prior treatment in a halo. All three patients had evidence of bony union at the fracture site on subsequent radiological follow up. The remaining four patients were initially treated in a halo and had delayed surgery. After surgery two of these four patients had radiological evidence of bony union at the fracture site, one remained non-united and one patient has not yet been fully assessed.
Conclusions
In this small series, operative fixation for C2 fracture lead to bony union at the fracture site in 5 out of 6 cases where full follow up was available. Interestingly, bony union at the fracture site may be an achievable objective even when surgery has been delayed or is not the primary treatment.
