Age, sex, predisposing factors to falls, cause of injury, treatment, presence of autofusion in the subaxial cervical spine, and mortality rates were compared between fracture patterns. Fractures were classified as odontoid Type I, II, or III hangman's C-2 complex (hangman's appearance on sagittal images, Type III odontoid on coronal cuts) and other (miscellaneous). Patients who sustained a axis fracture fracture between 20 and who were admitted to the authors' Level 1 trauma center were identified using the Discharge Abstract Database and the International Statistical Classification of Diseases and Related Health Problems (ICD-10) code S12.1. These results help to stratify patients with isolated C2 fractures that are at high VAI risk and should be further evaluated with CTAĪ retrospective cohort study design was used. Transverse foramen fracture alone was not found to be significant. The C2 fracture pattern most associated with VAI was comminuted transverse foramen fracture with intraforaminal fragments. Fracture patterns significantly associated with VAI were Type III dens and transverse foramen fractures with intraforaminal fragments, with or without comminution. 29.9% had miscellaneous coronal/sagittal fractures and 22.4% were a combination.Vertebral artery injury was identified in 37.3% patients with isolated C2 fractures, and 88% had transverse foramen involvement. Fracture pattern analysis revealed that the majority were dens fractures (50.8%) and traumatic spondylolisthesis (41.8%). Sixty-seven patients met inclusion criteria. Fisher exact and student-t tests were performed to determine predictors of VAI based on fracture type. Corresponding CTAs were assessed for vertebral artery injury based on the Denver grading criteria. Fractures were classified using multiplanar CT images into Type-I/II/IIa/III spondylolisthesis, Type-I/IIA/IIB/IIC/III dens, transverse foramen (displacement/ comminution/intraforaminal fragments), and miscellaneous vertebral body fractures. Exclusion criteria included penetrating injury or additional cervical/occipital fractures. Imaging-based fracture classification schemes to determine which patterns are predictors of VAI in isolated C2 fractures using CTA have not been described.Ĭervical-spine CTs at a level I trauma center were reviewed for isolated C2 fractures from 2004-2014 under institutional board review approval. Early screening for vertebral artery injury to institute antithrombotic treatment is critical to prevent ischemic neurologic sequelae. The vertebral arteries are susceptible to injury as each courses through the C2 transverse foramen.
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