Intraoperative color-coded duplex ultrasound for safe surgical reduction of displaced hangman fractures in patients with atypical course of the vertebral artery: A case report of two patients.

Autor:	Oswald KAC; Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Deml MC; Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Heldner MR; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Seiffge D; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Bigdon SF; Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Albers CE; Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Jazyk:	angličtina
Zdroj:	Trauma case reports [Trauma Case Rep] 2021 Dec 09; Vol. 37, pp. 100573. Date of Electronic Publication: 2021 Dec 09 (Print Publication: 2022).
DOI:	10.1016/j.tcr.2021.100573
Abstrakt:	An atypical course of the vertebral artery can be medically relevant in displaced Hangman fractures, especially if the artery course runs within the fracture gap of the C2 isthmus. During surgical reduction, the artery can be occluded inside the fracture, potentially leading to ischemic conditions of the brain. The aim of this study was to report two cases according to the CARE (case reporting) guidelines, in which intraoperative color-coded duplex-ultrasound was performed to secure safe surgical reduction of hangman fractures in two patients with an atypical course of the vertebral artery. Two patients with displaced hangman fractures (Effendi-Levine type II) were diagnosed with an atypical course of the vertebral artery running inside the fracture gap. This endangered safe surgical management with the risk of iatrogenic occlusion or injury during reduction through entrapment of the vessel inside the fracture gap. Therefore, an intraoperative color-coded duplex-ultrasound of the vertebral artery was conducted before and after reduction of the fracture, as well as at the end of the surgery. The surgical treatment in both cases included posterior unilateral spondylodesis, followed by anterior cervical discectomy and fusion (ACDF). In both patients, a safe reduction of the fracture was performed. Neither occlusion nor dissection of the vertebral artery occurred. The duplex ultrasound before and after reduction, and at the end of the procedure showed normal blood flow and morphology of both vertebral arteries. At follow-up examinations, the patients showed a favorable clinical outcome, radiographic signs of fusion, and no irregularity of the vertebral arteries. This case report serves as proof-of-concept, demonstrating the feasibility of this regimen to minimize the risk of entrapment or occlusion of the vertebral artery in the surgical management of displaced Hangman fractures with atypical course of the vertebral artery running inside the fracture gap. Competing Interests: The authors indicate no potential conflict of interest. The authors have no relevant financial or non-financial interests to disclose. (© 2021 The Authors.)
Databáze:	MEDLINE
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