C2 Body Fracture: Report of Cases Managed Conservatively by Philadelphia Collar

Study design: Case series.

Purpose: To present results of conservative management in patients with pure C2 body fractures.

Overview of literature: Axis body fractures, a less common subgroup of C2 fractures, are commonly classified as vertical coronal, vertical sagittal, and transverse subtypes. While the treatment paradigm for other C2 fractures is clear, there is insufficient evidence to support treatment guidelines for C2 body fractures.

Methods: Eleven patients with pure C2 body fractures were managed with external immobilization and followed thereafter.

Results: All neurologic examinations were normal. In computed tomography (CT) scans, four, two, three, and two patients had a coronal, sagittal, horizontal, and burst fracture, respectively. Magnetic resonance imaging showed hematoma and partial rupture in the anterior longitudinal ligament in four patients, posterior ligamentous complex injury in one, and normal ligamentous structure in six. All fractures were managed conservatively using the Philadelphia collar, which was continued until complete disappearance of symptoms (within 1-3 months in all patients). The decision to discontinue the neck collar was made by a dynamic neck X-ray and CT scan that showed complete bony fusion. All patients were then followed for an additional 1.5 years (mean follow-up of 21 months for all patients). No patient showed any neurologic symptoms or deficits during the follow-up period.

Conclusions: In patients with pure C2 body fracture, non-operative management with Philadelphia neck collar is a safe and efficacious option, even in the presence of some sort of ligamentous injury.