Huge Teardrop Fracture of the Axis: Literature Review and Case Report
Juan Pablo Santelices1, Rodrigo Donoso2*, Daniel Palma3, Marcos Ganga1,4 and Cristián Santos1,5
1Spine Surgeon, Equipo de Cirugía de Columna, Clínica Santa María, Santiago, Chile
2Orthopedic Surgeon, Spine surgery fellow, Universidad de Chile, Chile
3Orthopedic Surgery Resident, Universidad de Chile, Chile
4Associate Professor, Universidad de Chile, Orthopedic Surgery Program, Spine Surgery Division, Chile
5Spine Surgeon, Spine Surgery Chief, Equipo de Cirugía de Columna, Clínica Santa María, Santiago, Chile
*Corresponding Author: Rodrigo Donoso, Orthopedic Surgeon, Spine surgery fellow, Universidad de Chile, Chile.
September 20, 2021; Published: November 10, 2021
Huge teardrop fracture of the axis is an uncommon injury, mainly caused by high energy trauma. Despite of being described for the first time in 1956, the evidence is still scarce.
Purpose: To review the literature, analyze and discuss the treatment options and its results for this type of fracture. We present a clinical case of huge teardrop fracture of the axis.
Methods: Literature review between 1956 and 2020, discussion of the treatment options and results. Description of the treatment method and results in our mentioned clinical case.
Results: We present a patient with a huge teardrop fracture of the axis due to high energy trauma (parachute diving accident by malfunction of main device). Treatment decision is discussed considering the eventual benefits and risks, finally performing a C2-C3 anterior fusion augmented with iliac crest autograft. There are 79 cases described in the literature, but the cases solved by surgery are not more than 20.
Keywords: Huge Teardrop Axis Fracture; Teardrop Fracture, Axis Fracture; Cervical Fusion; Anterior Approach; Cervical Arthrodesis
- Kahn E A and R C Schneider. “Chronic neurological sequelae of acute trauma to the spine and spinal cord. I. The significance of the acute-flexion or tear-drop fracture-dislocation of the cervical spine”. The Journal of Bone and Joint Surgery. American Volume 38-A.5 (1956): 985-997.
- Hu Yong., et al. “Conservative and Operative Treatment in Extension Teardrop Fractures of the Axis”. Clinical Spine Surgery1 (2016): E49-54.
- Korres D S., et al. “The "tear drop" (or avulsed) fracture of the anterior inferior angle of the axis”. European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society3 (1994): 151-154.
- Yang Xiaobin., et al. “Treating Huge Tear-Drop Fracture of Axis With Trapezoidal Bone: A Case Report and Literature Review”. Spine22 (2015): E1187-1190.
- Kovacs Francisco M., et al. “Psychometric characteristics of the Spanish version of instruments to measure neck pain disability”. BMC Musculoskeletal Disorders 9 (2008): 42.
- Park Soo-An., et al. “Topographical anatomy of the anterior cervical approach for c2-3 level”. European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 7 (2013): 1497-1503.
- Russo Antonino., et al. “Submandibular approach to the C2-3 disc level: microsurgical anatomy with clinical application”. Journal of neurosurgery. Spine4 (2009): 380-389.
- Boran Sun., et al. “Functional outcome following teardrop fracture of the axis”. European Journal of Orthopaedic Surgery and Traumatology3 (2005): 229-232.
- Xu Guanhua., et al. “Tear-drop fracture of the axis in a child with an 8-year follow-up: a case report”. Journal of Pediatric Orthopedics. Part B3 (2014): 299-305.
- Ma Litai., et al. “Anterior Reduction, Discectomy, and Three Cortical Iliac Bone Grafting With Instrumentation to Treat A Huge Tear Drop Fracture of the Axis: A Case Report and Literature Review”. Medicine 15 (2016): e3376.
- Govindan Nijith O., et al. “Anterior Cervical Plating for An Axis Tear Drop Fracture: Case Report”. International Journal of Orthopaedics5 (2016): 650-653.
- Jiang, Tao., et al. “Anterior reduction and fusion for treatment of massive tear drop fracture of axis combining with inferior endplate serious traversed lesion: A retrospective study”. Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association5 (2017): 816-821.
- Watanabe Masahiko., et al. “Clinical features of the extension teardrop fracture of the axis: review of 13 cases”. Journal of Neurosurgery. Spine6 (2011): 710-714.
- Chan M., et al. “Cervical spine injuries and collar complications in severely injured paediatric trauma patients”. Spinal Cord5 (2013): 360-364.
- Webber-Jones Joan E., et al. “The management and prevention of rigid cervical collar complications”. Orthopedic Nursing 4 (2002): 19-25; quiz 25-27.
- Vialle R., et al. “Fracture « tear-drop » en extension de l’axis: À propos d’un cas traité chirurgicalement”. Revue de Chirurgie Orthopédique et Réparatrice de l'Appareil Moteur2 (2004): 152-155.
- Xin Xin., et al. “Zero-Profile Implantation Combined with Miniscrew Fixation via Anterior Approach for Huge Teardrop Fracture of Axis”. World Neurosurgery 128 (2019): 235-239.