transoral screw and wire fixation for unstable anterior ½ atlas fracture

Study Design: Atlas fractures are evaluated according to the fracture type and ligamentous injury. External immobilization may result in fracture nonunion. Objective: The ideal treatment method for non-stabilized atlas fractures is limited fixation without restricting the range of motion of the atlantoaxial and atlantooccipital joints. Summary of Background Data: Such a result can be established by using either anterior fixation or posterior lateral mass fixation. However, none of these techniques can fully address anterior 1/2 atlas fractures such as in this case. Materials and Methods: A transoral technique in which bilateral screws were placed intralaminarly and connected with wire was used to reduce and stabilize an anterior 1/2 fracture of C1. Result: Radiological studies after the surgery showed good cervical alignment, no screw or wire failure and good reduction with fusion of anterior arcus of C1. Conclusions: Internal immobilization by this screw and wire osteosynthesis technique protects the mobility of the atlanto-occipital and atlantoaxial joints. The main advantage is that neither the twisted wires inserted under the anterior lamina, nor the laterally placed screw heads interfere with midline wound closure; unlike the plate/cage and rod systems used together with anterior screws. A computer navigation system with intraoperative 3D imaging facilities will be of benefit for safe placement of the screw, however we preferred a free-hand technique, as the starting point was at the fracture line along the trajectory of the routinely accessible anterior lamina.