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Anterior and posterior fixation for delayed treatment of posterior atlantoaxial dislocation without fracture
  1. Hai Ming Yu1,
  2. Karan Malhotra2,
  3. Joseph S Butler2,
  4. Shi Qiang Wu1
  1. 1Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
  2. 2Royal National Orthopaedic Hospital, Stanmore, UK
  1. Correspondence to Karan Malhotra, karanm83{at}


Posterior atlantoaxial dislocation (PAAD) without fracture of the odontoid process is a rare injury. Authors have variously reported closed or open reduction, followed by either anterior or posterior fixation, but there is no consensus on best treatment. We present a particularly unstable case of PAAD. Open reduction through a retropharyngeal approach with odontoidectomy was required for reduction. Anterior fixation with transarticular lag screws was required prior to posterior fixation with pedicle screws. Despite non-compliance with postoperative immobilisation, imaging at 20-month follow-up confirmed solid fusion. The patient is pain-free with a good range of movement of the neck and has returned to a manual job. Our case had a greater degree of instability than was previously reported, which necessitated 360° fixation. This is the first reported case of this treatment strategy, which provided a very stable fixation allowing fusion despite early movement and without causing undue stiffness.

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