case_images: PMC10668072_01
case_images: Preop CT scan of C1. a) axial, b) coronar, c) saggital plane.
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case_images: fig1
case_images: IV with additional non-displaced posterior arch fracture (Fig. 1). Additionally, a minor traumatic brain injury, several rib fractures, burst fractures of the thoracic spine (Th 4: A3 and Th5: A4 according to AO spine), dislocated wrist fracture, and perilunate dislocation on the left side were diagnosed. Initially, the dislocated wrist and carpus were fixed, and the spine was immobilized with a stiff collar and bed rest.
case_images: Exposure with self-retractor with screw in situ after stabilization.
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case_images: fig2
case_images: Next, a self-retaining oral retractor, usually used for tonsillectomy, was placed to visualize the soft palate, followed by repeated disinfection enorally with betadine (Fig. 2).
case_images: Ap/lateral fluoroscopy to mark the entry point with a k-wire.
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case_images: fig3
case_images: The entry point was localized again with a k-wire and verified under fluoroscopy in two planes (Fig. 3).
case_images: Ap/lateral fluoroscopy to verify the correct drill position for the screw.
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case_images: PMC10668072_01_gr4.jpg
case_images: fig4
case_images: The fluoroscopy in two planes showed the correct position of the drill (Fig. 4).
case_images: Ap/lateral fluoroscopy with the placed screw.
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case_images: The fracture gap was closed (Fig. 5).
case_images: Intraoperative 3D scan with C-arm to confirm correct reposition and screw-position axial (a) and coronal (b).
case_images: gr6.jpg
case_images: PMC10668072_01_gr6.jpg
case_images: fig6
case_images: After removing the retractor, we verified the fracture gap's correct screw placement and closure with an intraoperative 3D scan (Ziehm Vision RFD 3D, Ziehm Imaging GmbH, Germany) (Fig. 6).
case_images: Follow-up x-ray (a/b) and CT-scan (c/d) after six weeks with correct screw position and no loss of reduction.
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case_images: fig7
case_images: In addition, the CT scan showed anatomical reduction and stable fracture fixation (Fig. 7).
case_images: Follow-up x-ray (a/b) after 6 months with the unchanged position.
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case_images: fig8
case_images: At the next follow-up visits after 12 weeks and 6 months, the patient remained pain-free with nearly physiological movement conducting ambulatory physical therapy (Fig. 8).