Oblique axis body fracture—Pitfalls in management

Abstract Background Transverse fractures through the body of the axis, rather than at the base of the odontoid are uncommon and management with an external orthosis is usually recommended. Oblique fractures through the body of the axis accompanying a hangman's fracture have not been reported and are not described as part of any classification system. Such fractures may be at high risk for treatment failure in an external orthosis. Case description We report on a case of an oblique axis fracture that failed treatment with external orthosis. Posterior instrumented fusion was employed successfully using a C1–C3 and C4 poly axial screw rod construct. Frameless stereotaxy and a biomodel were useful surgical adjuncts. Twelve month follow up revealed bony union in an asymptomatic patient. Conclusions Oblique fractures of the body of the axis can displace in a halo-thoracic orthosis. Serial radiological review is required to detect displacement prior to fracture union. Oblique fractures of the body of the axis can be managed surgically with preservation of atlanto-occipital motion, resulting in satisfactory clinical and radiological outcomes.