Posterior osteosynthesis with a new self-designed lateral mass screw-plate system for unstable atlas burst fractures

• Published in: BMC musculoskeletal disorders 2023-02, Vol.24 (1), p.108-108, Article 108
• Main Authors: Yang, Kun, Niu, He-Gang, Tao, Hui, Liu, Chang, Cao, Yun, Li, Wei, Zhang, Jing-Jing, Shen, Cai-Liang, Zhang, Yin-Shun
• Format: Article
• Language: English
• Subjects: Antibiotics; Atlas fracture; Bone Screws; C1 fracture; Cervical Atlas - diagnostic imaging; Cervical Atlas - injuries; Cervical Atlas - surgery; Fracture Fixation, Internal - methods; Fractures; Fractures, Bone - complications; Humans; Internal fixation in fractures; Joints; Ligaments; Medical imaging; Medical records; Musculoskeletal diseases; Neck pain; Neurological complications; Open reduction and internal fixation (ORIF); Osteosynthesis; Patient outcomes; Patients; Range of motion; Retrospective Studies; Spinal Fractures - complications; Spinal Fractures - diagnostic imaging; Spinal Fractures - surgery; Spine; Spine (cervical); Surgery; Tomography; Transverse atlantal ligament (TAL); Treatment Outcome; Vertebrae; Wound infection
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-023-06209-z

In the treatment of unstable atlas fractures using the combined anterior-posterior approach or the posterior monoaxial screw-rod system, factors such as severe trauma or complex surgical procedures still need to be improved despite the favourable reduction effect. This research described and evaluated a new technique for the treatment of unstable atlas fracture using a self-designed lateral mass screw-plate system. A total of 10 patients with unstable atlas fractures using this new screw-plate system from January 2019 to December 2021 were retrospectively reviewed. All patients underwent posterior open reduction and internal fixation (ORIF) with a self-designed screw-plate system. The medical records and radiographs before and after surgery were noted. Preoperative and postoperative CT scans were used to determine the type of fracture and evaluate the reduction of fracture. All 10 patients were successfully operated with this new system, with an average follow-up of 16.7 ± 9.6 months. A total of 10 plates were placed, and all 20 screws were inserted into the atlas lateral masses. The mean operating time was 108.7 ± 20.1 min and the average estimated blood loss was 98.0 ± 41.3 ml. The lateral mass displacement (LMD) averaged 7.1 ± 1.9 mm before surgery and almost achieved satisfactory reduction after surgery. All the fractures achieved bony healing without reduction loss or implant failure. No complications (vertebral artery injury, neurologic deficit, or wound infection) occurred in these 10 patients. At the final follow-up, the anterior atlantodens interval (AADI) was 2.3 ± 0.8 mm and the visual analog scale (VAS) was 0.6 ± 0.7 on average. All patients preserved almost full range of motion of the upper cervical spine and achieved a good clinical outcome at the last follow-up. Posterior osteosynthesis with this new screw-plate system can provide a new therapeutic strategy for unstable atlas fractures with simple and almost satisfactory reduction.