IOA 2022

Traumatic Posterior Atlantoaxial Dislocation with an associated Fracture: Meta-analysis and Systematic Review

Ahmad Essa 1,2 Salah Khatib 1,2 Oded Rabau 1,2 Yossi Smorgick 1,2 Yigal Mirovsky 1,2 Yoram Anekstein 1,2
1Department of Orthopaedics, Shamir Medical Center (Assaf Harofeh), Israel
2Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Objective:
Traumatic posterior atlantoaxial dislocation with fracture (TPAD) is an extremely rare entity, with limited number of cases reported in literature. We conducted a systematic review and meta-analysis of all cases of TPAD with fracture reported in literature to investigate the clinical presentation, injury mechanism, patients’ characteristics, diagnosis, treatment, and prognosis of this entity.

Methods:
This systematic meta-analysis review was conducted following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Relevant literature was retrieved from Pubmed data base from the earliest entry dates till 2021. All published English written prospective, retrospective, systematic review, meta-analysis, case series and case reports studies involving human subjects with relevant data regarding TPAD were included.

Results:
Twenty-two case series and case reports published between 1924-2021 describing 28 patients with TPAD were included. Median age at presentation was 51.5 years, with male predominance (83%). The relevant injury history included motor vehicle accident (45%), fall from height (41%) and other. The most common fracture pattern was Anderson and D`alonzo type II odontoid fracture (78%), followed by anterior arch of C 1 fracture (18%). Neurologic exam at presentation was intact in 52% of patients. The primary diagnostic imaging was Computed tomography (CT) employed in 96% of cases. The management consisted of 2 stages protocol, initially a temporary axial traction was employed (54%), later definitive surgical treatment was employed (93%). Posterior surgical approach was favoured in 82% of cases.

Conclusion:
TPAD with fracture is considered a rare entity occurring in majority of cases with Anderson and D`alonzo type II odontoid fracture, predominantly in males following MVA or fall from height. Diagnosis is usually established based on CT imaging; further imaging may not be indicated as it doesn’t seem to alternate patient’s management course. Surgical intervention was employed in almost all cases with favoured results via posterior C1-C2 fusion.