This document discusses fractures of the atlas (C1 vertebra). It notes that atlas fractures make up around 7% of cervical spine fractures and have a low risk of neurological injury. They are commonly missed on initial imaging due to the location at the occipitocervical junction. Mechanisms of injury include hyperextension, lateral compression, and axial compression. Around 50% have an associated spine fracture and 40% are associated with an axis (C2) fracture. Imaging such as CT is the preferred method to delineate fracture patterns and identify other cervical spine injuries. Conservative treatment with a hard collar or halo immobilization for 6-12 weeks is indicated for stable fractures with an intact transverse ligament. S

1. Atlas fracture
Nikita Sharma
BPT 7 SEM

2. Fracture of atlas
INTRODUCTION-
• Epidemiology
• make up ~7% of cervical spine fractures
• risk of neurologic injury is low
• commonly missed due to inadequate imaging of occipitocervical junction
• Pathophysiology
• mechanism
• includes hyperextension, lateral compression, and axial compression
• Associated conditions
• spine fracture
• 50% have an associated spine injury
• 40% associated with axis fx
• Prognosis
• stability dependent on degree of injury and healing potential of transverse ligament

6. Imaging
• Radiographs
• lateral radiographs
• CT
• study of choice to delineate fracture pattern and
identify associated injuries in the cervical spine
• MRI
• more sensitive at detecting injury to transverse
ligament

10. Conservative treatment
• hard collar vs. halo immobilization for 6-12 weeks
• indications
• stable Type I fx (intact transverse ligament)
• stable Jefferson fx (Type II) (intact transverse ligament)
• stable Type III (intact transverse ligament)
• technique
• controversy exists around optimal form of
immobilization

11. Surgical treatment
• posterior C1-C2 fusion vs. occipitocervical fusion
• indications
• unstable Type II (controversial)
• unstable Type III (controversial)
• technique
• may consider preoperative traction to reduce
displaced lateral masses