Dens Fracture Research Articles

Three neglected cases of minor trauma to the craniovertebral junction with potentially disastrous consequences

Os odontoideum is a rare congenital anomaly predisposing to atlantoaxial instability. It may rarely present with a history of trivial trauma followed by slow progressive features of compressive myelopathy. Dens fractures, though not uncommon, may also remain undiagnosed and present later on with nonunion. Hence, it is very important for these patients to undergo proper clinical evaluation and appropriate imaging.

Reliability of treating asymptomatic traumatic type II dens fractures in patients over age 80: A retrospective series.

Background:Management of type II odontoid fractures in elderly remains controversial to whether surgical treatment is favored over conservative one. This is a study of geriatric patients with asymptomatic type II dens fractures who after sustaining a fall were initially evaluated at community hospitals. They were placed in a rigid collar and were followed up in a spine clinic.Purpose:To assess the reliability of treating very old patients with type II dens fracture conservatively and whether surgical intervention if needed would affect the clinical outcome.Study Design:Retrospective study with the literature review.Patient Sample:Consecutive patients above 80 years of age, who sustained a clinically asymptomatic type II dens fracture and were observed after a conservative treatment plan, was initiated.Outcome Measures:Outcome measures included self-reported worsening neck pain, neurological function, and radiographic measures over the follow-up period.Materials and Methods:A retrospective clinical analysis of 5 active geriatric patients with type II asymptomatic dens fracture. After evaluating them, treatment options were discussed with patients and their family members. The decision was to continue to follow them with a rigid collar very closely since they were reluctant to undergo any surgical procedure.Results:Patients were followed for an average of 29 months. They were observed for any worsening neck pain, neurological deficit, or deterioration of fracture on follow-up imaging studies. At last follow-up, 2 of 5 patients continued to be asymptomatic, the 3rd died of unrelated causes while 2 others required surgeries at least 1-year post injury.Conclusions:Treatment of type II dens fractures in the elderly is controversial. Independent elderly patients who are asymptomatic at presentation may be safe to be followed up very closely with a neck brace and serial X-ray. Converting to surgical treatment can be done safely when needed without affecting the overall clinical out.

Morphometric Analysis of Axis and Its Clinical Significance -An Anatomical Study of Indian Human Axis Vertebrae.

The atlas and axis vertebra have unique shape and complex relationship with vertebral artery. Fracture of dens of axis accounts for 7-27% of all cervical spine fractures, but surgeries in these regions are highly risky because of the reported incidences of vertebral artery injury. The study was designed to measure morphometric data of human axis vertebra, of Indian origin. The different anatomical parameters on dry specimen of human axis vertebrae were established and the results were compared with other studies. Thirty intact human axis vertebrae were measured with digital vernier caliper and mini-inclinometer. Various linear and angular parameters of axis were observed. The mean distance from the midline of body to the tip of transverse process of axis was 29.32 mm on right side and 29.06mm on left side. The mean distance from the midline of body to the lateral most edge of superior articulating facet was 22.8 mm on right side and 22.6 mm on left side. The mean value of anterior and posterior height of axis was 34.33±2.69mm and 30.56±2.78mm respectively. The anterior and posterior height of body of axis was 19.67 mm and 16.67mm respectively. Mean A-P and transverse diameter of inferior surface of axis was 15.42mm and 17.7mm respectively. Mean transverse diameter and mean A-P diameter of odontoid process was 9.32 mm and 10.1 mm respectively. Mean anterior and posterior height of the odontoid process was 14.66 mm and 13.89mm respectively. Mean of dens axis sagittal angle (angle between an axis that was imagined to pass longitudinally through the dens axis and the vertical line on a sagittal plane) was 13.23 degree. The shape of superior articulating facets of C2 varies from oval to circular. In the present study, 84% of SAF were oval and 16% were circular. Inferior articulating facets were circular in shape in 90% cases, and oval in 10% vertebra. Mean pedicle width was 10.07mm on right side and 10.52mm on left side. Mean transverse diameter of vertebral canal was 22.37±1.73mm. Mean of A-P diameter of vertebral canal at inlet was 18.31±2.05mm and mean of A-P diameter of vertebral canal at outlet was 14.84±1.63mm. These results obtained from this study may be helpful for the surgeons in avoiding and minimizing complications such as vertebral artery injury, cranial nerve damage and injury to other vital structures while doing surgery around cranio-vertebral region.

Radiologic Presentation of a Type 1 Dens Fracture

A 22-year-old man with no significant medical history presented with multiple life-threatening injuries due to a high-speed motor vehicle accident. He was neurologically intact. Admission computed tomography (CT) of the spine illustrated an oblique avulsion of the tip of the odontoid process with slight superior displacement of the proximal fragment, consistent with a type 1 dens (ie, odontoid) fracture (Figures 1-3). Additional imaging displayed a small epidural hematoma posterior to the fracture and ligamentum flavum discontinuity at the C1-C2 level, overall indicative of the acuity of the type 1 dens fracture (Figures 4,5). The injury resulted in instability of the atlanto-occipital articulation predominantly involving the lateral mass articulations with the occipital condyles, requiring placement of a halo and occipital cervical fusion and instrumentation (Figure 6). Anderson and D’Alonzo described 3 types of dens fractures with type 1 being the rarest, defined as an

Prevalence of degenerative changes of the atlanto-axial joints

Background contextDegeneration of the atlantodens and atlanto-axial joints is associated with cervical spine pain and may also be associated with an increased risk of dens fracture. However, there is paucity of literature describing the prevalence of specific degenerative changes in the atlantodens and atlanto-axial facet joints. PurposeTo document age-related degenerative changes of the cervical spine in a large cohort of patients. Study design/settingThis is a retrospective cohort study. Patient sampleAdult trauma patients were admitted to our Level 1 trauma center. Outcome measuresOsteoarthritis of the atlantodens and atlanto-axial facet joints of the cervical spine and the presence of intraosseous cyst and calcific synovitis, as determined by computed tomography (CT) scans. MethodsWe conducted a retrospective study of 1,543 adult trauma patients who received a cervical spine CT scan. The anterior atlantodens joint interval was measured. The presence or absence of intraosseous cysts and calcific synovitis was recorded. Degeneration of the atlantodens and atlanto-axial facet joints at age intervals was quantified. ResultsThe atlantodens interval narrowed linearly with age (R2=0.992, p<.001). The prevalence of intraosseous cysts increased exponentially with age from 4.2% to 37.4%, and calcific synovitis increased from 0% to 11.1%. Intraosseous cyst formation generally began in the second and third decades of life and synovitis in the fifth and sixth decades of life. Facet joints also demonstrated age-related changes; however, the rate of degenerative changes was lower than in the atlantodens joint. ConclusionsTo our knowledge, this is the first study that documents specific changes of both atlantodens and atlanto-axial facet joints as a function of age in a large cohort of 1,543 patients. These changes increased exponentially with age and may contribute to pain and limitation in motion. In light of our findings and recent studies demonstrating the association between degeneration and dens fracture in elderly, cervical spine radiographs of elderly patients should be carefully assessed for these changes.

Degenerative changes in the atlanto-dens joint and dens fractures in the elderly: close relatives or just neighbors?: a commentary on an article by Matthew S. Shinseki et al.: "association between advanced degenerative changes of the atlanto-dens joint and presence of dens fracture".

Dens fractures in the elderly continue to haunt modern health care. These injuries are especially prevalent in this more frail patient population; they can present following seemingly trivial trauma; and, with the dramatic growth of the geriatric sector of our general population, it is reasonable to assume that the incidence of these injuries will increase. Moreover, dens fractures in the elderly are extremely challenging to treat, and are associated with a high incidence of morbidity and mortality regardless of whether operative or nonoperative treatment is used. Although certain patient characteristics (age, female sex, osteoporosis, and senility) have been linked to dens fractures in general, their association with specific upper cervical spine anatomic abnormalities has yet to be determined. Shinseki et al. investigated potential associations between advanced degenerative changes in the atlanto-dens joint and dens fractures in the elderly. They are not the first to do so. In 1942, Olsson1 described arthrosis of the median facet of the atlas and the dens process, which he reported could cause pain and limit neck motion. Almost fifty years later, Genez2 touted thin-section, high-resolution computed tomography (CT) with reconstruction as the best way to depict atlanto-dens osteoarthritis and recognized that the physiological abnormalities associated with these changes had yet to be described. Several years later, in a …

Instabilité du rachis cervical par traumatisme en compression axiale : une étude biomécanique

BackgroundAxial compression injuries of the cervical spine occur during contact sports, automobile collisions, and falls. The objective of this study was to use flexibility tests to determine biomechanical instability of the cervical spine due to simulated axial compression injuries. HypothesisWe hypothesized that the axial compression injuries cause severe biomechanical instability throughout the cervical spine. Materials and methodsThe injuries were simulated using 2.4m/s head-first impacts of a cadaveric cervical spine model (n=10) mounted horizontally to a torso-equivalent mass on a sled and carrying a surrogate head in protruded posture. Intact and post-impact flexibility tests were performed up to 1.5, 3, and 1.5 Nm in flexion-extension, axial torque, and lateral bending, respectively. Instability parameters of range of motion (RoM) and neutral zone (NZ) were determined for injured spinal levels and statistically compared (P<0.05) between intact and post-impact. ResultsThe sagittal instability parameters indicated extension-compression injuries at the upper and middle cervical spine and flexion-compression injuries at the lower cervical spine. Increases in extension RoM were 14.9° at the upper cervical spine and 24.9° (P<0.05) at the middle cervical spine and in flexion RoM at C7/T1 were 25.6°. RoM and NZ increases in axial rotation and lateral bending were nearly symmetric among left and right. DiscussionMultidirectional instability of the upper cervical spine caused by atlas and dens fractures was evidenced by increases between 36% and 53% in RoM and NZ due to the impacts. The sagittal RoM of injured spinal levels of the middle and lower cervical spine exceeded a proposed threshold for clinical instability by between 67% and 114%. The instability documented throughout the cervical spine was consistent with clinical observations of cord injuries and paralysis in patients. Level of evidenceLevel IV, controlled laboratory investigation.

Cervical spine instability following axial compression injury: A biomechanical study

BackgroundAxial compression injuries of the cervical spine occur during contact sports, automobile collisions, and falls. The objective of this study was to use flexibility tests to determine biomechanical instability of the cervical spine due to simulated axial compression injuries. HypothesisWe hypothesized that the axial compression injuries cause severe biomechanical instability throughout the cervical spine. Materials and methodsThe injuries were simulated using 2.4m/s head-first impacts of a cadaveric cervical spine model (n=10) mounted horizontally to a torso-equivalent mass on a sled and carrying a surrogate head in protruded posture. Intact and post-impact flexibility tests were performed up to 1.5, 3, and 1.5Nm in flexion-extension, axial torque, and lateral bending, respectively. Instability parameters of range of motion (RoM) and neutral zone (NZ) were determined for injured spinal levels and statistically compared (P<0.05) between intact and post-impact. ResultsThe sagittal instability parameters indicated extension-compression injuries at the upper and middle cervical spine and flexion-compression injuries at the lower cervical spine. Increases in extension RoM were 14.9° at the upper cervical spine and 24.9° (P<0.05) at the middle cervical spine and in flexion RoM at C7/T1 were 25.6°. RoM and NZ increases in axial rotation and lateral bending were nearly symmetric among left and right. DiscussionMultidirectional instability of the upper cervical spine caused by atlas and dens fractures was evidenced by increases between 36% and 53% in RoM and NZ due to the impacts. The sagittal RoM of injured spinal levels of the middle and lower cervical spine exceeded a proposed threshold for clinical instability by between 67% and 114%. The instability documented throughout the cervical spine was consistent with clinical observations of cord injuries and paralysis in patients. Level of evidenceLevel IV, controlled laboratory investigation.

Type III dens fracture with vertical distraction

A 10-year-old boy was involved in a high-speed motor vehicle collision. At the scene of the accident, he was awake and complaining of neck pain. The boy was placed in a Philadelphia collar and transferred to our hospital. On admission, general physical and neurologic examinations were normal. Cervical spine radiograph and computed tomographic scan demonstrated a displaced type III dens fracture (Figs. 1 and 2). The patient was treated with skeletal skull traction (1.5 kg). One hour after traction, the patient felt progressive limb anesthesia and dyspneic respiration.

Surgery May Lead to Better Function and Quality of Life in Geriatric Patients with Type-II Dens Fracture

Surgery May Lead to Better Function and Quality of Life in Geriatric Patients with Type-II Dens Fracture

Elderly patients are at increased risk for mortality undergoing surgical repair of dens fractures

ObjectiveDens fractures are common cervical injuries in advanced aged patients. The presented study was undertaken to analyze the clinical results and risks of surgically treated patients with dens fractures over 70 years. MethodsData of 28 patients (17 female, 11 male) over 70 years treated from September 2004 to October 2009 were recorded. Clinical and radiological parameters were obtained including type of fracture, associated cervical and/or other injuries, comorbidities, symptoms, neurological condition, surgical strategy, postoperative course and complications. Results89% were in a good neurological condition before surgery (ASIA E or D). In most cases, surgery was performed at an early stage after trauma (21 patients within 5 days). Ventral screw fixation was the preferred surgical strategy (64%). A slight worsening of neurological functions immediately after operation was only seen in one patient. Five patients died in the early and 2 in the late postoperative course which means a treatment mortality of 25%. Among the surviving patients two had general medical complications. ConclusionType II dens fractures are a common fracture of elderly patients. Our results are good concerning the neurological functions. Surgical and general medical complications were acceptable. However, the study also underlines that mortality rate is high and therefore treatment options should be well-considered in this high risk group.

Functional and Quality-of-Life Outcomes in Geriatric Patients with Type-II Dens Fracture

Dens fractures are relatively common in the elderly. The treatment of Type-II dens fractures remains controversial. The aim of this multicenter prospective cohort study was to compare outcomes (assessed with use of validated clinical measures) and complications of nonsurgical and surgical treatment of Type-II dens fractures in patients sixty-five years of age or older. One hundred and fifty-nine patients with a Type-II dens fracture were enrolled in a multicenter prospective study. Subjects were treated either surgically (n = 101) or nonsurgically (n = 58) as determined by the treatment preferences of the treating physicians and the patients. The subjects were followed at six and twelve months with validated outcome measures, including the Neck Disability Index (NDI) and Short Form-36v2 (SF-36v2). Treatment complications were prospectively recorded. Statistical analysis was performed to compare outcome measures before and after adjustment for confounding variables. The two groups were similar with regard to baseline characteristics. The most common surgical treatment was posterior C1-C2 arthrodesis (eighty of 101, or 79%) while the most common nonsurgical treatment was immobilization with use of a hard collar (forty-seven of fifty-eight, or 81%). The overall mortality rate was 18% over the twelve-month follow-up period. At twelve months, the NDI had increased (worsened) by 14.7 points in the nonsurgical cohort (p < 0.0001) compared with a nonsignificant increase (worsening) of 5.7 points in the surgical group (p = 0.0555). The surgical group had significantly better outcomes as measured by the NDI and SF-36v2 Bodily Pain dimension compared with the nonsurgical group, and these differences persisted after adjustment. There was no difference in the overall rate of complications, but the surgical group had a significantly lower rate of nonunion (5% versus 21% in the nonsurgical group; p = 0.0033). Mortality was higher in the nonsurgical group compared with the surgical group (annual mortality rates of 26% and 14%, respectively; p = 0.059). We demonstrated a significant benefit with surgical treatment of dens fractures as measured by the NDI, a disease-specific functional outcome measure. As a result of the nonrandomized nature of the study, the results are vulnerable to the effects of possible residual confounding. We recommend that elderly patients with a Type-II dens fracture who are healthy enough for general anesthesia be considered for surgical stabilization to improve functional outcome as well as the union and fusion rates.

Chronic Neck Pain Associated with an Old Odontoid Fracture: A Rare Presentation

Cervical spine injuries represent a minority of injury cases in motor vehicles accidents but are a real threat to a patient's life. In the wide range of cervical spine injuries, odontoid (dens) fractures represent the most common findings. These fractures are more usually found in the elderly population due to the changes associated with age. Neurological deficit is not frequently found in these injuries. The following is a case presentation of a chronic odontoid fracture with neurological deficit in a young man that was discovered 23 years after he sustained a motor vehicle accident.

Anterior Screw Fixation for Odontoid Fracture Using the Direct Approach at the C2-C3 Level: Case Report and Literature Review

Fractures of the odontoid process comprise 10–15% of all cervical fractures. Almost two thirds of all dens fractures are classified as type II according to Anderson and D’Alonso classification system. Currently, the direct anterior odontoid screw fixation provides the best anatomical and functional results for this type of fracture and it is considered as the treatment of choice. Regarding the approach to the C2 vertebra, about 80% of authors usually make a skin incision at the lower cervical level (C4-C5 or C5-C6) for creating a working corridor. However, the required exposure and the relatively blind passage of the screw can damage the surrounding soft tissue. The direct approach at the C2- C3 level could be a shorter and safer working corridor to the odontoid screw fixation with less soft tissue retraction. Here we present a case report of a 62-year-old man who presented with Type II odontoid fracture and subsequently underwent a direct anterior odontoid screw fixation through a mini-open approach at the C2-C3 level. The literature available in the English language on related-approach complications of anterior odontoid screw fixation is reviewed.

New Clinical Classification System for Atlantoaxial Dislocation

The purpose of this study was to define a new clinical classification of atlantoaxial dislocation based on its clinical manifestations, namely reducible atlantoaxial dislocation (RAAD), irreducible atlantoaxial dislocation (IAAD), and fixed atlantoaxial dislocation (FAAD). A total of 107 patients with atlantoaxial dislocation were respectively treated based on this clinical classification, including 66 patients with RAAD, 39 patients with IAAD, and 2 patients with FAAD. Six of the 66 patients with RAAD with rotatory atlantoaxial dislocation were treated with traction and a cervical collar, 9 with fresh type II dens fracture were treated with cannulated screw fixation, and 51 were treated with posterior atlantoaxial or occipitocervical arthrodesis. Thirty-eight patients with IAAD received a transoral atlantoaxial reduction plate system, and 1 with a giant cell tumor was treated with lesion resection and vertebral reconstruction by a shaped titanium mesh system followed by posterior occipitocervical screw-rod fixation. The 2 patients with FAAD underwent anterior decompression and received a transoral atlantoaxial reduction plate system. Follow-up data were obtained for a minimum of 6 months. All patients' neurological symptoms improved postoperatively. Bony union was accomplished by 3-month follow-up. Donor-site infection was found in 1 patient, with no occurrence of other complications. This article proposes a new classification of atlantoaxial dislocation indicating the severity and difficulty in reduction of the atlantoaxial joint. The classification system assists with decision making regarding therapeutic options. Transoral atlantoaxial reduction plate fixation and posterior atlantoaxial screw-rod fixation are commonly performed for atlantoaxial dislocation.

Treatment Algorithm for Dens Fractures: Non-Halo Immobilization, Anterior Screw Fixation, or Posterior Transarticular C1-C2 Fixation

The appropriate treatment of dens fractures is unclear. We established a staged treatment protocol for dens fractures and conducted a prospective study to evaluate the outcome of treatment based on this protocol. We prospectively evaluated sixty-nine consecutive patients who presented to our institution with a dens fracture. The mean duration of follow-up was 9.7 months (range, six to fifty-eight months). Fractures were categorized as stable or unstable. Stable fractures were treated by immobilization in a rigid collar. Patients seventy-five years or older with unstable fractures, patients with a neurological deficit, and patients with Anderson and D'Alonzo type-III fractures underwent posterior transarticular C1-C2 stabilization. Unstable fractures in patients younger than seventy-five years were stabilized with direct anterior screw fixation. Thirty-one patients were treated with a Philadelphia collar, twenty-five with posterior transarticular fixation, and thirteen with direct anterior screw fixation. Fracture-healing or solid fusion of C1-C2 was documented in sixty-eight of sixty-nine treated patients at final follow-up. The remaining patient had a stable nonunion of the dens. Secondary procedures were performed in five patients. Our treatment algorithm based on dens fracture type, fracture stability, and patient age was associated with a high success rate. Evaluating fracture stability is crucial when considering nonoperative treatment. External stabilization with a rigid cervical collar was adequate for stable fractures of the dens and was associated with a high healing rate. Posterior transarticular screw fixation of C1-C2 was associated with a high success rate, including in elderly patients. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Preliminary Biomechanical Proof of Concept for a Hybrid Locking Plate/Variable Pitch Screw Construct for Anterior Fixation of Type II Odontoid Fractures

A human cadaveric biomechanical proof-of-concept study. To test whether adding a locking plate to the anterior surface of C2 attaching directly to the interfragmentary screw may reduce potential for anterior screw cutout and improve construct strength. The most common mode of failure for screw fixation of dens fractures is via cutout at the anterior body of C2. A human, cadaveric model of type II dens fractures was created and fixed using either a headless, fully threaded variable pitch screw (FTVPS) or a screw with an attachable locking plate construct (LPC). Following quasistatic loading to failure, stiffness and load to failure were compared using t tests. Mode of failure was determined from radiographical and gross inspection. Load to failure was greater for the LPC than for the FTVPS alone (498 N vs. 362 N, P = 0.04). The LPC consistently failed via compression of cancellous bone posterior to the lag screw, whereas the FTVPS constructs failed via cutout of the screw from the anterior C2 body. Locking plate supplementation of anterior screw fixation of type II odontoid fractures improves construct strength and changes the failure mechanism from anterior screw cutout to posterior displacement of the screw. An attachable locking plate/interfragmentary screw construct may improve clinical outcomes for these fractures.

One-Screw Fixation Provides Similar Stability to That of Two-Screw Fixation for Type II Dens Fractures

Anterior screw fixation has been widely adopted for the treatment of type II dens fractures. However, there is still controversy regarding whether one- or two-screw fixation is more appropriate. We addressed three questions: (1) Do one- and two-screw fixation techniques differ regarding shear stiffness and rotational stiffness? (2) Can shear stiffness and rotational stiffness after screw fixation be restored to normal? (3) Does stiffness after screw fixation correlate with bone mineral density (BMD)? We randomly assigned 14 fresh axes into two groups (seven axes each): one receiving one-screw fixation and another receiving two-screw fixation. Shear and torsional stiffness were measured using a nondestructive low-load test in six directions. A transverse osteotomy then was created at the base of the dens and fixed using one or two screws. Shear and torsional stiffness were tested again under the same testing conditions. Mean stiffness in all directions after screw fixation was similar in both groups. The stiffness after one- and two-screw fixation was not restored to normal: the mean shear stiffness restored ratio was less than 50% and the mean torsional stiffness restored ratio was less than 6% in both groups. BMD did not correlate with mean stiffness after screw fixation in both groups. One- and two-screw fixation for type II dens fractures provide similar stability but neither restores normal shear or torsional stiffness. One-screw fixation might be used as an alternative to two-screw fixation. Assumed BMD should not influence surgical decision making.

The Effect of Soft-Tissue Restraints After Type II Odontoid Fractures in the Elderly

A biomechanical analysis of soft-tissue restraints to passive motion in odontoid fractures. To quantify the role of the C1-C2 facet joint capsules and anterior longitudinal ligaments (ALLs) in the setting of a type II odontoid fracture in the elderly. The odontoid process itself is the primary stabilizer at the C1-C2 level; however, little is known about the role of the soft-tissue structures that remain intact in the setting of an odontoid fracture after a low-energy mechanism. Ten cadaveric C0-C2 spinal segments were studied. Specimens were tested under simulated axial rotation with an applied moment of ±1 Nm and with an application of a 10 N anteriorly directed force to the body of C2 to induce sagittal translation. Optical motion data were initially collected for the intact state and after a simulated dens fracture. The specimens were then divided into 2 groups, where 1 group underwent unilateral and then bilateral C1-C2 facet capsular injuries followed by an ALL injury. The second group underwent the ALL injury before the same capsular injuries. Changes in axial range of motion and C1-C2 translation were analyzed using 2-way repeated measures analyses of variance and post hoc Student-Newman-Keuls tests (α = 0.05). In axial rotation, there was an increase in range of motion by approximately 13%, with the fracture of the dens compared with the intact state (P < 0.05). An increase was also present for each subsequent soft-tissue injury state compared with the previous (P < 0.05); however, there was no difference found between the 2 sectioning protocols. For sagittal translation testing, it was found that the odontoid fracture alone showed an increase of 3 mm of C1-C2 translation compared with intact (P < 0.05). Further soft-tissue injuries did not show an increase until the complete injury state. This study identifies that type II odontoid fractures without associated soft-tissue injury may be stable under certain loading modes.

Treatment of Dens Fractures With Posterior Atlantoaxial Dislocation With Transoral Atlantoaxial Reduction Plate Surgery

Case report. To describe a rare old dens fracture with posterior atlantoaxial dislocation that was treated with transoral atlantoaxial reduction plate surgery. Dens fractures with posterior atlantoaxial displacement are not common and cause ventral compression of the spinal cord. Management of this type of fracture is through skull traction and external fixation, posterior laminectomy and fusion, or transoral reduction and posterior fusion. A 38-year-old man sustained a car accident and was diagnosed with type II dens fractures (the classification system of Anderson and D'Alonzo) and posterior atlantoaxial dislocation. The neurological function of the patient was C grade according to the standard neurological classification of spinal cord injury from the American Spinal Association. Because of multiple trauma involving the head, lung, and the abdomen, he was treated with skull traction with about 10° of flexion. No signs of reduction were observed. The patient was treated operatively 70 days after the injury. We performed a transoral atlantoaxial reduction plate surgery using a transoral approach for release, reduction, and fixation. Finally, anterior fusion with iliac bone graft was applied. Complete atlantoaxial reduction and decompression of the spinal cord were achieved. The patient felt better after surgery. Movement of his extremities raised from grade II-III force to grade IV-V, and neurological status improved from American Spinal Association grade C to D. The treatment option achieved instant reduction, decompression, and fixation. A new treatment option for this type of injury is recommended.