Temporary Occiput–C2 Fixation for Unstable Atlas Fractures: A Reliable Alternative to Halo-Vest? Minimum Two-Year Clinical Outcomes

Study Design Retrospective study. Objectives This study aimed to assess clinical and radiological outcomes of temporary occiput–C2 fixation(TOC2F) as an alternative to halo-vest immobilization in unstable atlas fractures. Methods After ethics approval, 43 patients treated for C1 fractures between 2011-2018 were reviewed.Inclusion criteria were acute traumatic C1 fractures managed with TOC2F and at least two years of follow-up after implant removal. Exclusion criteria were polytrauma affecting follow-up, pathological fractures, prior cervical surgery, congenital anomalies, and incomplete data. Preoperative imaging included MRI, CT, MR angiography, and X-ray. Union was evaluated with CT at 3 and 6 months. Functional outcomes were assessed using NDI, SF-36 (MCS/PCS), and goniometric cervical rotation. Results The cohort consisted of 23 patients(16 male,7 female).According to Landells classification,78.2% had type II and 21.7% type III fractures. Radiological union was achieved in all patients by 6 months, with hardware removal at a mean of 6.3 months. Cervical rotation significantly improved from 103.78° ± 12.02 at day 4 to 153.78° ± 9.29 at two years( P < .05).NDI scores improved from 12.21 ± 3.66 to 2.14 ± 0.94( P < .05).Final SF-36 MCS/PCS scores were favorable 56.33/56.09).No neurological deterioration occurred; one superficial wound complication was documented. Conclusion TOC2F demonstrates potential as a viable and effective alternative for the management of unstable C1 burst fractures.This technique provides immediate postoperative stability, facilitates reliable fracture union, and allows restoration of physiological cervical motion following implant removal.The favorable functional outcomes, low complication rate, and preserved long-term mobility observed in this study suggest that temporary fixation may offer substantial advantages over halo-vest immobilization and permanent fusion in appropriately selected patients.