Single fracture in the atlas vertebral arch: analysis of an unusual event.

STUDY

DESIGN

Retrospective study.

OBJECTIVE

The aim of this study is to show that a single traumatic fracture of the atlas is unusual but not rare and requires specific management strategies, which can be highlighted by the study of the junctional ligaments and membranes.

SUMMARY OF BACKGROUND DATA: A single traumatic fracture of the atlas arch is considered a rare event and has been analyzed in few case reports. Ligaments and membranes play a primary role in providing stability to the craniovertebral junction area.

METHODS

Here, we report 10 cases of a single traumatic fracture of the atlas arch: 4 cases were part of our series of spine injuries and were studied by magnetic resonance imaging during the acute phase to assess the junctional ligaments. The remaining 6 cases were obtained from the Literature.

RESULTS

Indirect signs of a traumatic ligamentous injury were found only in 1 patient. However, in all cases, these fractures were considered biomechanically stable and all patients were discharged with a rigid collar. During the follow-up, all patients reported an improvement in their neck pain and tenderness, with radiologic signs of bone healing.

CONCLUSIONS

A single fracture of the atlas arch is an unusual traumatic event that results from slow-force impact. Medical experience in treating this specific fracture subtype is nowadays poor because of the paucity of the literature; thus, this unusual condition may either be underestimated or even overstudied and overtreated. Nowadays, it seems reasonable to assume that the management should be conservative in all cases and that magnetic resonance imaging often plays only a marginal role.