Plough fracture, a burst fracture of the atlas with C1-C2 dislocation, is a very rare and unstable form of fracture. Here we describe a case of this injury that was treated by C1-C2 posterior instrumentation.
An 81-year-old man was involved in a motor accident and admitted to our hospital. He had a scalp laceration in the frontal region. Neurological examination revealed Frankel C paralysis and hypesthesia below C3. A cervical X-ray film showed fracture of the atlas, and T2-weighted MRI showed a high-intensity area in the spinal cord at C1-C2. CT showed bilateral vertical fracture of the anterior arch, a fracture of the posterior arch, and C1-C2 dislocation. The C1-occiput joint remained intact. No fracture of the axis was evident.
Gardner traction was performed for 7 days, followed by C1-C2 posterior fusion with a screw and rod system. CT scan 3 months after surgery showed adequate fusion of C1-C2, and plain radiography showed no instability. By this time, the patient’s neurological deficit had improved, and he was able to use a wheelchair.
Plough fracture is a rare and unstable type of fracture that can be treated by posterior C1-C2 fusion with a screw and rod system. This technique was safe in the patient case, and reliable stability was obtained.
