Management of combination fractures of the atlas and axis: a report of four cases and literature review.

Four cases of combination fractures of the atlas and axis are presented. Three types of management were performed: plaster immobilization, odontoid screw fixation combined with atlantoaxial pedicle screw fixation, occipito-cervical fusion with anterior operation by staged. Based on a literature review and our experience, treatment strategies is discussed according to the stability of the upper cervical spine and neurological involvement, with a reminder that combined injuries in the upper cervical spine should be sought in any patient with a cervical injury and early surgical solution may bring benefits once injury attack.