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Paper title Evolution In Management Of Combined Atlas - Hangman's Fracture
Paper code P28
Authors
  1. PANKAJ SINGH All India Institute of Medical Sciences, New Delhi Speaker
  2. Satish Verma All India Institute of Medical Sciences, New Delhi
  3. Dattaraj Sawarkar All India Institute of Medical Sciences, New Delhi
  4. Amandeep Kumar All India Institute of Medical Sciences, New Delhi
  5. Deepak Agarwal All India Institute of Medical Sciences, New Delhi
  6. P Sarat Chandra All India Institute of Medical Sciences, New Delhi
  7. Shashank Kale All India Institute of Medical Sciences, New Delhi
Form of presentation Poster
Topics
  • SSNS-Neurosurgery
Abstract text Abstract: Introduction:Combined C1-Hangman fractures are uncommon and
management usually compromises C1-C2 mobility.
Objective: To evaluate treatment and outcome of combined C1- hangman's
fracture with and without intraoperative O- arm based navigation system
Methods : Out of Eleven patients (18.33%) of combined C1 and hangman's
fracture, we included 10 patients in our study who had at least 6 month
follow up. Neurological deficit was present in 4 patients (ASIA B in 1
patient , ASIA C in 2 patients and ASIA D in 1 patient). Operative
intervention was performed in 9 patients. Specific treatment was
determined by the combination of fractures. O-arm was used in 5 patients
and its use allowed more anatomical and more motion preserving procedure
in these 5 patients. In 1 patient C2 pedicle screws and C3 lateral mass
screw and rod fixation, and in 4 patients C2 pedicle screw and C3-C4
lateral mass screw and rod fixation was done.
Results: Mean follow-up period was 28.7 ± 9.2 months. Neurological
recovery occurred in all 4 patients with preoperative neurological
deficits. Radiological fusion occurred in all cases. Rotation at C1-2
was preserved in all cases.
Conclusions: The goals in treating these complex fractures are to
achieve early maximum stability and preserving maximum range of motion.
These are often competing phenomena. Treatment in these combination
fractures is based on the type of hangman's fracture. Good healing can be
achieved in elderly patients also and we should be aggressive in managing
these patients with new intra operative CT scans and navigation system.