Revision 5 for 'C2 fracture'

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newCervical, thoracic and lumbar fracture in a multitrauma patient

This patient has multiple injuries including multiple cervical vertebral fractures. 

Cervical fractures can be divided into two main categories2:

  • upper cervical fractures (C1 (atlas) and C2 (axis))
  • lower cervical fractures (C3 - C7)

In this case, the patient has an upper cervical axial fracture of C2 as well as a lower cervical C6 fracture. 
C2 or axial fractures can be divided into four main types1:

  • Type I: fracture without an angular deviation and translational deviation of less than 3.5 mm that occurs due to hyperextension and axial compression;
  • Type II: fracture with a significant translational or angular deviation that occurs due to hyperextension and axial compression combined with a mechanism of flexion-compression;
  • Type IIa: fracture with a small translational deviation and wide angulation, with an increase in posterior disc space between C2-C3 upon application of traction that occurs due to a flexion-distraction; and
  • Type III: fracture with a large translational and angular deviation, which is associated with unilateral or bilateral dislocation of the C2-C3 joint facets and occurs due to a flexion-compression mechanism.

Due to the minimal amount of angular or translational deviation, our patient has a type I C2 fracture. These fractures can be managed non-operatively with immobilization for a period of 12 weeks.

Subaxial fractures (C3 - C7 fractures) can be assessed using the Subaxial Injury Classification score3. It is a 3 part scoring system, which gives a total possible score out of 10. The 3 parts to be considered include:

  • Morphology of the vertebral injury
  • Disc-ligamentous complex
  • Neurological status

A score of 4 or more warrants surgical intervention.

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