Neurosurgical management of acute atlas-axis combination fractures. A review of 25 cases.

Combination atlas-axis fractures occur relatively frequently and have a higher incidence of neurological morbidity than isolated C-1 or isolated C-2 injuries. Patients with combination C1-2 fracture-subluxation injuries should be studied with thin-section computerized tomography. Appropriate treatment is determined by the type of axis fracture present and includes surgical and nonsurgical strategies. An experience with 25 patients with combination C1-2 fractures is presented, and management and follow-up guidelines are reviewed.