Surgical treatment of atypical unstable Hangman fracture in elderly osteoporotic patients / 中国骨伤

ABSTRACT

OBJECTIVE@#To explore the clinical effect of operative reduction and internal fixation in treating atypical unstable Hangman fracture in elderly osteoporotic patients.@*METHODS@#The clinical data of 9 elderly osteoporotic patients with atypical unstable Hangman fracture treated from December 2012 to December 2017 were retrospectively analyzed. There were 5 males and 4 females with an average age of 72.7 years (range 65 to 79) old. The fracture line was located on bilateral inferior articular surface or lamina with anterior dislocation of axis in 3 cases (similar to Levine-Edwards type II); one side of the fracture line was located on the lower articular surface and opposite side involved on the upper articular surface and the body of axis with atlantoaxial lateral mass dislocation in 4 cases; the fracture line was located at the pedicle of the axis, transverse foramen and posterior inferior wall of the vertebral body, accompanying by anterior and posterior longitudinal ligaments and C₂-C₃ intervertebral disc injury resulted in C₂-C₃ intervertebral instability in 2 cases. According to ASIA grade of spinal cord injury, 2 cases were grade D and 7 cases were grade E. Preoperative JOA scores were 9 to 11 points with an average of 9.8 points. All patients underwent routinely skull traction for reduction. Three patients with anterior dislocation of axis were treated with stage I anterior-posterior internal fixation and 6 patients with simple posterior pedicle screw fixation. Postoperative JOA score, ASIA system and the imaging data were used to evaluate clinical effects.@*RESULTS@#All patients were followed up from 12 to 20 months with an average of 18 months. The neck pain disappeared after operation and cervical spine movement was well in all patients. The improvement rate of JOA at 3 months after operation was 75% to 87.5%. Two cases of ASIA grade D fully recovered to grade E. All fractures healed at 6 to 12 months after operation. Except one case occurred superior laryngeal nerve injury and had a complete recovery after 3 months, the other patients had no complications like spinal cord and vertebral artery injury, plate screw loosening and wound infection.@*CONCLUSIONS@#According to the type of atypical unstable Hangman fracture in elderly osteoporotic patients, choosing a reasonable and personalized surgical plan can achieve immediate cervical stability and well reduction, which is beneficial for early ambulation and quick rehabilitation.