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Skull Base 2011; 21(4): 249-254
DOI: 10.1055/s-0031-1280679
ORIGINAL ARTICLE

© Thieme Medical Publishers

Do Concomitant Cranium and Axis Injuries Predict Worse Outcome? A Trauma Database Quantitative Analysis

Prashant Chittiboina1 , Anirban Deep Banerjee1 , Anil Nanda1
  • 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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Publication History

Publication Date:
22 June 2011 (online)

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ABSTRACT

We performed a trauma database analysis to identify the effect of concomitant cranial injuries on outcome in patients with fractures of the axis. We identified patients with axis fractures over a 14-year period. A binary outcome measure was used. Univariate and multiple logistic regression analysis were performed. There were 259 cases with axis fractures. Closed head injury was noted in 57% and skull base trauma in 14%. Death occurred in 17 cases (6%). Seventy-two percent had good outcome. Presence of abnormal computed tomography head findings, skull base fractures, and visceral injury was significantly associated with poor outcome. Skull base injury in association with fractures of the axis is a significant independent predictor of worse outcomes, irrespective of the severity of the head injury. We propose that presence of concomitant cranial and upper vertebral injuries require careful evaluation in view of the associated poor prognosis.

KEYWORDS

Cervical spine - axis fractures - craniovertebral junction - skull base - trauma database

REFERENCES

  • 1 Greene K A, Dickman C A, Marciano F F, Drabier J B, Hadley M N, Sonntag V K. Acute axis fractures. Analysis of management and outcome in 340 consecutive cases.  Spine (Phila Pa 1976). 1997;  22 (16) 1843-1852
    CrossrefPubMedGoogle Scholar
  • 2 Isolated fractures of the axis in adults.  Neurosurgery. 2002;  50(3, Suppl) S125-S139
    CrossrefPubMedGoogle Scholar
  • 3 Dashti R, Ulu M O, Albayram S, Aydin S, Ulusoy L, Hanci M. Concomitant fracture of bilateral occipital condyle and inferior clivus: what is the mechanism of injury?.  Eur Spine J. 2007;  16(Suppl 3) 261-264
    CrossrefPubMedGoogle Scholar
  • 4 Harris Jr J. The cervicocranium: its radiographic assessment.  Radiology. 2001;  218 (2) 337-351
    PubMedGoogle Scholar
  • 5 Daffner R H. CT of the craniovertebral junction.  AJR Am J Roentgenol. 1996;  167 (2) 365-366
    PubMedGoogle Scholar
  • 6 Kirshenbaum K J, Nadimpalli S R, Fantus R, Cavallino R P. Unsuspected upper cervical spine fractures associated with significant head trauma: role of CT.  J Emerg Med. 1990;  8 (2) 183-198
    CrossrefPubMedGoogle Scholar
  • 7 Link T M, Schuierer G, Hufendiek A, Horch C, Peters P E. Substantial head trauma: value of routine CT examination of the cervicocranium.  Radiology. 1995;  196 (3) 741-745
    CrossrefPubMedGoogle Scholar
  • 8 Sun P P, Poffenbarger G J, Durham S, Zimmerman R A. Spectrum of occipitoatlantoaxial injury in young children.  J Neurosurg. 2000;  93(1, Suppl) 28-39
    CrossrefPubMedGoogle Scholar
  • 9 Cunningham J, Brison R J, Pickett W. Concussive symptoms in emergency department patients diagnosed with minor head injury.  J Emerg Med. 2011;  40 (3) 262-266
    CrossrefPubMedGoogle Scholar
  • 10 Krakenes J, Kaale B R, Rorvik J, Gilhus N E. MRI assessment of normal ligamentous structures in the craniovertebral junction.  Neuroradiology. 2001;  43 (12) 1089-1097
    CrossrefPubMedGoogle Scholar
  • 11 Bloom A I, Neeman Z, Slasky B S et al.. Fracture of the occipital condyles and associated craniocervical ligament injury: incidence, CT imaging and implications.  Clin Radiol. 1997;  52 (3) 198-202
    CrossrefPubMedGoogle Scholar
  • 12 Hunink M GM. Decision making in the face of uncertainty and resource constraints: examples from trauma imaging.  Radiology. 2005;  235 (2) 375-383
    CrossrefPubMedGoogle Scholar
  • 13 Johnson F, Semaan M T, Megerian C A. Temporal bone fracture: evaluation and management in the modern era.  Otolaryngol Clin North Am. 2008;  41 (3) 597-618, x
    CrossrefPubMedGoogle Scholar
  • 14 Saboori M, Ahmadi J, Farajzadegan Z. Indications for brain CT scan in patients with minor head injury.  Clin Neurol Neurosurg. 2007;  109 (5) 399-405
    CrossrefPubMedGoogle Scholar
  • 15 Maas A IR, Steyerberg E W, Butcher I et al.. Prognostic value of computerized tomography scan characteristics in traumatic brain injury: results from the IMPACT study.  J Neurotrauma. 2007;  24 (2) 303-314
    CrossrefPubMedGoogle Scholar
  • 16 Feiz-Erfan I, Horn E M, Theodore N et al.. Incidence and pattern of direct blunt neurovascular injury associated with trauma to the skull base.  J Neurosurg. 2007;  107 (2) 364-369
    CrossrefPubMedGoogle Scholar
  • 17 Frye G, Wolfe T, Knopp R, Lesperance R, Williams J. Intracranial hemorrhage as a predictor of occult cervical-spine fracture.  Ann Emerg Med. 1994;  23 (4) 797-801
    CrossrefPubMedGoogle Scholar
  • 18 Koonsman M, Dunn E, Hughes K, Kendrick B, Moody J. How much monitoring is needed for basilar skull fractures?.  Am J Surg. 1992;  164 (5) 487-490
    CrossrefPubMedGoogle Scholar
  • 19 Society of Critical Care Medicine Ethics Committee . Consensus statement on the triage of critically ill patients.  JAMA. 1994;  271 (15) 1200-1203
    CrossrefPubMedGoogle Scholar
  • 20 Rodriguez R M, Wang N E, Pearl R G. Prediction of poor outcome of intensive care unit patients admitted from the emergency department.  Crit Care Med. 1997;  25 (11) 1801-1806
    CrossrefPubMedGoogle Scholar
  • 21 Hargrove J, Nguyen H B. Bench-to-bedside review: outcome predictions for critically ill patients in the emergency department.  Crit Care. 2005;  9 (4) 376-383
    CrossrefPubMedGoogle Scholar
  • 22 Murray G D, Butcher I, McHugh G S et al.. Multivariable prognostic analysis in traumatic brain injury: results from the IMPACT study.  J Neurotrauma. 2007;  24 (2) 329-337
    CrossrefPubMedGoogle Scholar
  • 23 Sharma B R. The injury scale—a valuable tool for forensic documentation of trauma.  J Clin Forensic Med. 2005;  12 (1) 21-28
    CrossrefPubMedGoogle Scholar

Anil NandaM.D. F.A.C.S. 

Chair and Professor, Department of Neurosurgery

P.O. Box 33932, LSUHSC, Shreveport, LA 71130-3932

Email: ananda@lsuhsc.edu

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