Clinical effects and risk factors of transoral Jefferson’s fracture reduction and plating in Jefferson’s fracture

To compare the clinic outcome of Jefferson-fracture reduction plate (JERP) or posterior pedicle screw-rod system in the treatment of Jefferson’s fracture and identify potential pre-operative risk factors for complications in patients treated with JERP system. A cohort of 68 patients with fresh Jefferson’s fracture who underwent reduction and fixation operation by our self-designed JERP plate or conventional posterior pedicle screw-rod system from June 2015 to June 2022 in our orthopedics center has been reviewed retrospectively. All the patients have been identified as Jefferson’s fracture (Gehweiler typeⅢa) by X-ray, CT and MR. Especially the transverse ligament remain intact and no dislocation of atlantoaxial junction has been found. All the patients presented with neck pain without neurological deficit. Forty-two patients underwent JERP system and twenty-six underwent posterior pedicle screw-rod system reduction and fixation. All the patients were followed up at least 12 months postoperatively. Parameters such as the operative time, blood loss, The visual analogue scale (VAS) score, distance to anterior arch fracture (DAAF), distance to posterior arch fracture (DPAF), lateral mass displacement (LMD) were retrospectively collected and statistically analyzed. Furthermore, we analyzed four preoperative characteristics for surgery-related complications, including age, gender, cause of injury and injury time. All 68 patients were followed up for 12 to 24 months. There was no significant difference in operation time, VAS scores and the incidence of postoperative complications between the two groups (P > 0.05). Compared with that in the control group, the blood loss in the JERP group was lower, and the length of hospital stay was longer. Furthermore, the JERP group had a smaller DAAF, shorter LMD and longer DPAF compared with the control group (P < 0.05). Furthermore, injury time (OR = 4.40; 95% CI, 1.05–20.69; P = 0.04) were significant associated with complications, whereas other variables were not. The JERP system achieves superior radiographic reduction of the atlas fracture (evidenced by improved postoperative DAAF, DPAF, and LMD) compared with the conventional posterior pedicle screw-rod system, but is associated with a longer hospital stay. Injury time may be associated with complications in patients treated with the JERP system, although this finding is based on univariate analysis and requires further validation.