C1 fracture: Analysis of consolidation and complications rates in a prospective multicenter series

Maxime Lleu (1) , Yann Philippe Charles (2) , Benjamin Blondel (3, 4) , Laurent Barresi (5) , Benjamin Nicot (6) , Vincent Challier (7) , Joël Godard (8) , Pascal Kouyoumdjian (9, 10) , Nicolas Lonjon (11) , Paulo Marinho (12) , Eurico Freitas (13) , Sébastien Schuller (2) , Stephane Fuentes (3, 4) , Jérémy Allia (5) , Julien Berthiller (14) , Cédric Barrey (13)

1 CHU Dijon
2 HUS - Les Hôpitaux Universitaires de Strasbourg
3 ISM - Institut des Sciences du Mouvement Etienne Jules Marey
4 TIMONE - Hôpital de la Timone [CHU - APHM]
5 CHU - Hôpital Pasteur [Nice]
6 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
7 CHU Bordeaux
8 Service de Neurochirurgie [CHRU Besançon]
9 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
10 BIOTIC - Biomécanique des Interactions et de l'Organisation des Tissus et des Cellules
11 Service de Neurochirurgie [CHRU Montpellier]
12 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
13 Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL]
14 IMER - Pôle Information Médicale Evaluation Recherche

Introduction: Three types of C1 fracture have been described, according to location: type 1 (anterior or posterior arc), type 2 (Jefferson: anterior and posterior arc), and type 3 (lateral mass). Stability depends on transverse ligament integrity. The main aim of the present study was to analyze complications and consolidation rates according to fracture type, age and treatment. Material and methods: The French Society of Spinal Surgery (SFCR) performed a multicenter prospective study on C1-C2 trauma. All patients with recent fracture diagnosed on CT were included. Consolidation on CT was studied at 3 months and 1 year. Medical, neurologic, infectious and mechanical complications were inventoried using the KEOPS database. Results: Sixty-three of the 417 patients (15.1%) had C1 fracture: type 1 (33.3%), type 2 (38.1%), or type 3 (28.6%). The transverse ligament was intact in 53.9% of cases. Treatment was non-operative in 63.5%of cases, surgical in 27.0%, and surgical after failure of non-operative treatment in 9.5%. There were 8 medical complications, more frequently in patients aged >70 years, following surgery (p < 0.0001). The consolidation rate was 84.2% with non-operative treatment, 100% for primary surgery, and 33.3% for secondary surgery (p = 0.002). There were 10 cases of non-union, in 4.8% of type 1, 13.6% of type 2 and 33.3% of type 3 fractures (p = 0.001). Conclusion: Medical complications showed association with age and with type of treatment. Non-operative treatment was suited to types 1, 2 and 3 with minimal displacement and intact transverse ligament. C1-C2 fusion was suited to displaced unstable type 2 fracture. Displaced type 3 fracture incurred risk of non-union. Early surgery may be recommended.

Mots clés: Atlas; C1 fracture; Complications; Consolidation; Non-union

Domaines: Médecine humaine et pathologie; Biomécanique [physics.med-ph]

Maxime Lleu, Yann Philippe Charles, Benjamin Blondel, Laurent Barresi, Benjamin Nicot, et al.. C1 fracture: Analysis of consolidation and complications rates in a prospective multicenter series. Orthopaedics & Traumatology: Surgery & Research, 2018, 104 (7), pp.1049-1054. ⟨10.1016/j.otsr.2018.06.014⟩. ⟨hal-02143088⟩