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Acute traumatic fractures to the craniovertebral junction: preliminary experience with the “MILD” score scale

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Traumatic fractures to the craniovertebral junction (CVJ) are rare events requiring complex clinical management. Several classification systems are currently in use; however, recent improvements of junctional knowledge has focused attention on the role of ligaments and membranes in vertebral biomechanical stability. The aim of this study was to present our preliminary experience with the “MILD” score scale, which should allow fast and effective classification of all CVJ traumatic fractures based on vertebral instability in the acute setting.

Methods

A prospective study was conducted on 38 consecutive patients with 43 traumatic junctional fractures identified by computed tomography (CT) scan in the acute trauma phase. The MILD scale was applied to all fractures, and a score was obtained for each patient. All cases underwent magnetic resonance imaging (MRI) to assess the anatomical integrity of ligaments and membranes.

Results

Twenty-seven patients (71 %) were classified as MILD type 1 (0–1 points), showed a negative MRI, and healed with conservative treatment. Eight patients (21 %) were classified as MILD type 2 (2 points) and showed modest indirect signs of ligamentous injuries. Four of these patients healed with conservative treatment, while three patients underwent surgery due to wide bone fracture fragment displacement. Three patients (8 %) were classified as MILD type 3 (3 points), all of whom showed extensive ligamentous damage and underwent surgery.

Conclusions

The close association between the MILD scale and spinal instability is promising, although further studies are warranted in order to confirm our preliminary data.

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Acknowledgments

Great thanks go to all our colleagues of the Neurosurgical, Neuroanesthesiologic, and Traumatologic Departments of Niguarda Cà Granda Hospital for their solid contribution to this work.

Conflict of interest

No conflict of interest is present. The authors did not receive any financial support for the article.

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Authors and Affiliations

  1. Department of Neurosurgery, Ospedale Niguarda Cà Granda, P.zza Ospedale Maggiore, 3, 20162, Milan, Italy

    A. Debernardi, G. D’Aliberti, G. Talamonti & M. Cenzato

  2. Department of Nursing Education, San Paolo Hospital, Milan, Italy

    E. Sala

Authors
  1. A. Debernardi
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  2. E. Sala
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  3. G. D’Aliberti
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  4. G. Talamonti
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  5. M. Cenzato
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Corresponding author

Correspondence to A. Debernardi.

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Debernardi, A., Sala, E., D’Aliberti, G. et al. Acute traumatic fractures to the craniovertebral junction: preliminary experience with the “MILD” score scale. Eur J Trauma Emerg Surg 40, 343–350 (2014). https://doi.org/10.1007/s00068-014-0387-6

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  • DOI: https://doi.org/10.1007/s00068-014-0387-6

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