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Atlas Fracture S12.000A

   

synonyms:Jefferson fracture, C1 fracture, Burst fracture, lateral mass fracture, first cervical vertebra fracture

Atlas Fracture ICD-10

Atlas Fracture Etiology / Epidemiology / Natural History

  • Typically high energy trauma

Atlas Fracture 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, Odontoid views:
    • 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