Surgical management of combined fracture of atlas associated with fracture of axis vertebrae (CAAF): Case Series

Combined fracture involving atlas together associated with axis (CAAF) accounts for approximately 3 % of traumatic cervical spine injury, CAAF are rarely reported, so modalities of management and outcome are not well understood, due to paucity of literature and only few reports reported in the form of isolated case report. CAFF management possess challenge as it is associated with high incidence non-union with previously conservative method. However, missed diagnosis and subsequent delay may be associated with catastrophic worsening in neurological deficit. So early diagnosis and management remains the key for successful neurological outcome. Such fractures are rare. Authors report five such cases of CAFF, all required surgical management with good outcome with no mortality. Current study, all cases were males (n=5), commonest mode of injury was fall (n=3), time interval since injury was within 24 hours in (n=4), however rest one presented after a gap of eight months. Commonest clinical feature was neck pain (n=3), neurological deficit (n=2), neck tenderness and swelling tenderness (n=3) Neuroimaging including X-ray, CT scan and MRI were carried out for all cases revealed fracture of arches of atlas (n=5), one case had multiple site fracture of both arches, odontoid fracture (n=2), lateral mass of atlas fracture in 1 cases. Astonishingly two cases had disruption of transverse ligament. Surgical procedures performed considering economic consideration included occipito-cervcial fusion (n=3), transarticular C1-C2 fusion and anterior odontoid screw fixation in one cases each. Management options in CAFF and review of literature discussed in present study