There are no universal atlas fracture treatment guidelines 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 patients 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 1).
Surgical management may be difficult and challenging due to the anatomical relationship between the vertebrae and neurovascular structures.
Level III 2)
: for isolated atlas fractures:
● 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