Atlas fracture treatment

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

Atlas fracture nonoperative management

see Atlas fracture surgery.