Atypical C2 fracture treated by posterior atlantoaxial fusion according to Goel/Harms.

Abstract

Atypical C2 fractures summarise all fracture types of the axis corpus that are not subsumed under odontoid fractures or traumatic spondylolisthesis of C2 (Hangman fractures). They are most often classified according to Benzel [1] in predominantly coronar (type 1), sagittal (type 2) and horizontal (type 3) plane fractures while an overlap to the ‘‘typical C2 fractures’’ is common. To differentiate stable from unstable atypical C2 fractures standard X-rays, CT and MRI are sometimes insufficient and have to be supplemented by a functional fluoroscopic evaluation in unclear cases. As an alternative to the atlantoaxial fixation technique according to Magerl [2], Goel [3] described in 1994 a posterior atlantoaxial screw-plate fixation and fusion technique. This technique was modified by Harms [4] in 2001 by improving the fixation with a screw-rod implant. The so-called Goel/Harms fixation of the atlantoaxial complex has meanwhile become a widely accepted, safe, and reliable operative standard for atlantoaxial fusion. Case description