Atlas Fracture

synonyms:Jefferson fracture, C1 fracture, Burst fracture, lateral mass fracture,

Atlas Fracture ICD-9

Atlas Fracture Etiology / Epidemiology / Natural History

• Typically high energy trauma

Atlas Fracture Anatomy

• See Spine anatomy.

Atlas Fracture Clinical Evaluation

• Palpate entire spine for tenderness / step off.
• Complete neuro exam: motor strength, pin-prick sensation, reflexes, cranial nerves, rectal examination (perineal pin-prick sensation, sphincter tone, volitional spincter control)
• Absence of the bulbocaverosus reflex indicates spinal shock. Level of spinal injury can not be determined until bulbocaverosus reflex has returned.
• See ASIA form.
• Burst fractures: pain when nodding the head

Atlas Fracture Xray / Diagnositc Tests

• A/P, Lateral, Odontoidviews:
• CT cervical spine:
• MRI:
• Burst fractures demonstrate bilateral symmetric overhang of the lateral masses of the atlas in relation ot the axis. Open month view demonstrates increased paradontoid space

Atlas Fracture Classification / Treatment

• Isolated anterior Arch, Posterior Arch, lateral mass fracture
  -Treatment = orthosis x 6-12 weeks
• Jefferson burst fracture:
  -Stable if combined lateral overhand of the atlas <7mm. Treatment = orthosis or halo x 12 weeks.
  -Unstable if transverse diameter of the atlas is >7mm greater then that of the axis, transverse ligament rupture should be suspected. Treatment = C1-2 fusion with Magerl screws or Harms technique.

Atlas Fracture Associated Injuries / Differential Diagnosis

• Occipital Condyle Fracture
• Occipitocervical Dissociation
• C2 fracture
• Odontoid fracture

Atlas Fracture Complications

Atlas Fracture Follow-up Care

Atlas Fracture Review References