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Papers of the Week

2022 Nov 01

BJR Case Rep



Atlanto-axial subluxation secondary to a neglected odontoid fracture.


Tsukamoto M, Morimoto T, Kobayashi T, Hirata H, Yoshihara T, Mawatari M
BJR Case Rep. 2022 Nov 01; 8(6):20220110.
PMID: 36632545.


A 81-year-old female had chronic renal failure and was undergoing hemodialysis, visited orthopaedic clinic after striking her head on the ceiling of a car while driving on a rough road. An odontoid fracture went unidentified on the initial radiograph. One month later, she came to our hospital with persistent neck pain. A radiography and computed tomography revealed a C1-two subluxation secondary to the fracture. Posterior occipito-C1-C2-C3 fixation was performed, and the patient wore a halo-vest for two-month post-surgery. After two months, the halo-vest was removed, and the patient was not experiencing any pain or neurological deficits. In older patients, even minor head trauma can result in cervical vertebral fractures. Therefore, potential fractures should be considered during initial evaluations to avoid the serious consequences of an incorrect initial diagnosis. Care should be taken when choosing between conservative or surgical treatments, considering all potential risks and complications.