Incidence and outcome of atlanto-occipital dissociation at a level 1 trauma centre: a prospective study of five cases wi
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ORIGINAL ARTICLE
Incidence and outcome of atlanto-occipital dissociation at a level 1 trauma centre: a prospective study of five cases within 5 years Franz Josef Mueller • Bernd Kinner • Michael Rosskopf • Carsten Neumann Michael Nerlich • Bernd Fuechtmeier
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Received: 9 March 2012 / Revised: 16 September 2012 / Accepted: 2 October 2012 / Published online: 18 October 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract Background Prospective evaluation of atlanto-occipital dissociations (AODs) at a level 1 trauma centre within 5 years. Methods Over a period of 5 years (2005–2009), all CT scans of the skull base and the upper cervical spine due to traumatic injuries were prospectively entered into a database. Furthermore, in cases of confirmed AOD all empirical data were prospectively collected. A more detailed data analysis of all AOD patients was conducted 2 years post-trauma. If required, another prospective follow-up was performed. Results 2,616 CT scans were performed in total. Out of these, there were five male patients with confirmed AOD. Thus, the total incidence was 0.2 %. AOD was associated with occipital condyle fractures in three out of the five cases. Three out of five patients (60 %) died due to the severity of the injury. It was possible to stabilise two patients surgically with a clinical/radiological follow-up 2 years post-surgery. At that time, one patient had an incomplete tetraplegia and was wheelchair ridden without needing ventilation, while the other patient suffered from post-traumatic stress disorder, but was able to walk and live alone. Conclusions AOD is a rarely seen injury, even in a level 1 trauma centre, and is associated with high morbidity and
F. J. Mueller (&) B. Kinner M. Rosskopf C. Neumann M. Nerlich Department of Trauma Surgery, University Hospital Regensburg, 93042 Regensburg, Germany e-mail: [email protected] B. Fuechtmeier Clinic for Orthopedic and Trauma Surgery, Hospital Barmherzige Bru¨der Regensburg, 93049 Regensburg, Germany
mortality. However, it is possible for adults to survive this severe occipito-cervical injury after surgical repair while maintaining the ability to walk. All the results and recommendations are still based on a low level of evidence, due to the low incidence of this injury. Keywords Outcome
Atlanto-occipital dissociation Surgery
Introduction Atlanto-occipital dislocations (AODs) and dissociations are rarely detected injuries, even in a level 1 trauma centre, and they are associated with a high level of mortality even during the preclinical phase [1–3]. An accurate incidence of AOD was reported by Bucholz and Burkhead [3] who reported an 8 % incidence (9 out of 112 victims of multiple traumas) of AOD following motor vehicle fatalities. Moreover, AOD was the single most common injury of the cervical spine in victims of multiple traumas, and the incidence in children was significantly higher than that in the adults in this series. Up to now, the clinical incidence of this traumatic injury has only been based on retrospective estima
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