====== Atlas fracture treatment ======

There are no universal [[atlas fracture]] [[treatment]] [[guideline]]s based on [[level I]] trials. Current treatment ranges from nonoperative to operative management depending on fracture-pattern and integrity of the surrounding ligaments. Furthermore, in the [[elderly patient]]s these fractures present a unique dilemma due to preexisting comorbidities and contraindications to various treatment modalities. C1 fractures warrant greater recognition to provide optimal treatment to patients and minimize the risk for developing complications
((Smith RM, Bhandutia AK, Jauregui JJ, Shasti M, Ludwig SC. Atlas Fractures: Diagnosis, Current Treatment Recommendations, and Implications for Elderly Patients. Clin Spine Surg. 2018 Aug;31(7):278-284. doi: 10.1097/BSD.0000000000000631. PMID: 29620588.)).
----
Surgical management may be difficult and challenging due to the anatomical relationship between the vertebrae and neurovascular structures. 

Level III
((Ryken TC, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, Theodore N, Walters BC, Hadley MN. Management of isolated fractures of the atlas in adults. Neurosurgery. 2013; 72 Suppl 2:127–131))

: for isolated [[atlas fracture]]s:

● Treatment is based on the [[atlas fracture classification]] and integrity of [[transverse ligament of the atlas]]

● if the [[transverse ligament of the atlas]] is intact: cervical immobilization alone

● if the [[transverse ligament of the atlas]] is disrupted: either (note: disruption of the TAL may be anatomic or physiologic)

a) [[cervical immobilization]] alone

b) or, surgical fixation and fusion



===== Nonoperative management =====

[[Atlas fracture nonoperative management]]
===== Surgery =====

see [[Atlas fracture surgery]].