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Traumatic Posterolateral Atlantoaxial Dislocation with Type II Odontoid Fracture: Case Report

Background context: The combination of atlantoaxial joint dislocation and odontoid process fracture is usually a lethal injury and as a result, reports of survivors are rare. In the last thirty years only fifteen clinical cases have been described.

Purpose: We present a case of a 30 year old patient with a traumatic posterolateral atlantoaxial dislocation (type V dislocation based on the Fielding classification), type II odontoid fracture and initial complete tetraplegia, who survived for 10 months after the accident.

Study design of case report

Methods: A review of the medical records since the time of initial hospital admission throughout follow-up was performed.

Results: The immediate first aid, uninterrupted rescue time, transfers to a level I trauma centre and the absence of cerebral vascular lesions contributed to the patient´s survival. The injury was immediately treated by reduction and internal stabilization of the occiput to C2-C4. After the surgery and transfer to rehabilitation clinic the complete tetraplegia did not recover and communication by the patient was only possible by eye- and eyelid movement. Due to severe complications resulting finally from the complete tetraplegia (cardiac arrhythmia, recurrent pneumonias leading to endocarditis, peritonitis and sepsis), the patient died after 10 months.

Conclusion: This rare case and presented management strategy underlines the significantly increased mortality rate with high cord injuries.

Author(s): Bretschneider H, Meyner T and Schneiders W

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