Coincident Fractures of the Atlas And Axis: Demographics, Presentation, Management, and Outcomes

Introduction: Coincident fractures of the atlas and axis increasingly common among older patients with traumatic injuries, pose challenges for management, and thus far have sparse outcomes data.

Methods: We retrospectively reviewed 65 cases of patients at San Francisco General Hospital (San Francisco, CA), who had coincident atlas and axis fractures. Fracture morphology and subsequent union/non-union was defined by imaging and clinical notes. Clinical demographics, co-morbidities, and neurologic deficits were extracted from notes. Univariate analyses were conducted with t-tests and Fisher exact tests as appropriate.

Results: Combined C1/C2 fractures predominantly happen in elderly individuals (73.8 years), and 49.2% of patients have neurological deficits. Univariate analyses demonstrate neurologic deficit as a significant predictor of mortality during admission (24.6% mortality, p=0.003). These have a high rate of non-union on follow-up (68.2% of patients, n=22 for those with sufficient follow-up). 23.8% of patients underwent surgery (15 out of 63 with data). Non-union was more pronounced in the conservative management group (75% vs. 50%, although this does not reach significance, p = 0.334). In our series, females were less likely to undergo surgery (20% of surgical cases were female, vs 54.2% of non-operative cases, p = 0.02). Of the remaining 48 patients who survived hospitalization, 15 were known to have died after hospitalization (31.3%).

Conclusion : Coincident atlas and axis fractures predominantly affect the elderly and have a high rate of non-union. Patients with this fracture pattern have both a high inpatient mortality and mortality on follow-up. Further research will help determine the optimal treatment strategies.