The Outcome of Fractures of the Second Cervical Vertebra Fractures: Should we be Quick to Operate?

Bilal Qutteineh Leon Kaplan Amir Hasharoni Schroeder Josh
Orthopedic Department, Hadassah Hospital, Israel

Background: C2 vertebra fractures can occur due to high-energy trauma or due to innocent falls in elderly patients. They are the most common fractures in the cervical spine. The literature is ambivalent regarding the need for surgical intervention in these fractures.The aim of this study is to review and evaluate the outcome of patients that had these fractures.

Materials and Methods: All patients admitted between 10/2006 to 12/2013 due to C2 vertebra fractures were included in the study. Patients medical records were retrospectively reviewed for fracture type, mechanism of injury, associated injuries, type of care, complications and long term follow up.

Results: 90 patients with C2 fractures were admitted .15 patients were excluded due to lack of follow up. Mean age was 55 years (range 3-97 year), 44 patients had C2 fracture due to motor vehicle accidents, and 31 patients had C2 fracture due to falls.

Dens fractures were present in 43 patients: 25 patients had type 2 dens fractures,18 patients had type 3 dens fractures. 24 patients had Hangman type fractures , 6 patients had C2 body fractures , one patient had unilateral pars c2 fracture , and another patient had fracture of posterior arch of C2.

12 patients with dens type 2 were treated conservatively.11 patients with dens type 2 underwent primary surgical fixation . During clinic follow up, 4 patients had failure of surgical fixation (36.6%), and 2 patients who were treated nonsurgicaly did not unite(both refused surgical treatment).

In the high energy injuries there was a high rate of head (28%), chest (22%) and limb injuries (37%). Associated vertebra fractures (24%) as were abdominal injuries (10%). The mortality rate was 12 % during initial hospitalization, one year mortality was 14.6%, 2 years mortality was 18.6 %.

Conclusion: C2 vertebra fractures are common fractures with very high mortality rate. Surgical intervention should be judicial as is associated with a high failure rate.