BACKGROUND Upper cervical spine injury involving C1 and C2 vertebrae are severe and at times fatal injury.  Such injuries can lead to instability and/ or spinal cord injury. These traumatic injuries sometimes can be difficult to diagnose, to manage and to treat. This retrospective study aims at evaluating the demographic profile and management of patients with C1, C2 fracture managed at Tertiary Center Hospital from 2014 September 1st till 2024 August 31st.

METHODS Retrospective analysis of patients with upper cervical spine injuries managed at Tertiary Care Center in 2014 September 1st till 2024 August 31st were done from data available in the electronic health record system. All the patients managed and discharged from the hospital during the period were screened and those with C1 and/or C2 fractures were included in the study. Their age, sex, mode of injury, duration of injury at the time of presentation, fracture types and treatment offered were analyzed.

RESULTS There was a total of 26 cases of upper cervical spine injury cases from 2013 August till 2024 September.  Out of which 21(80.8%) were male and 5 (19.2%) were female. Mean age was 35.88 ± 13.01 years (16-63 years). Road traffic accidents and Fall injury and road traffic accidents were two most common modes of injury (13 and 12 cases respectively). Injury of C2 vertebra was seen in 24 cases out of which 11 were odontoid fractures, 8 were hangman fractures and 5 were other types of C2 fractures. There were 2 cases involving C1 fracture. 5 cases (21.74 %) were managed conservatively and rest were managed operatively.

CONCLUSION C2 fractures were more common compared to C1 fractures. The most common mode of injury was road traffic accidents followed by fall from height. Most of the upper cervical spine injuries were managed surgically.

KEYWORDS C1 atlas vertebra, C2 axis vertebra, Hangman Fracture, Odontoid Fracture, Upper Cervical Spine Injury (UCSI)