Atlas Fractures and Atlas Osteosynthesis: A Comprehensive Narrative Review.
Publication Title
Journal of orthopaedic trauma
Document Type
Article
Publication Date
9-1-2017
Keywords
Adult; Aged; Cervical Atlas; Conservative Treatment; Fracture Fixation, Internal; Fracture Healing; Humans; Injury Severity Score; Magnetic Resonance Imaging; Male; Middle Aged; Narration; Prognosis; Risk Assessment; Spinal Fractures; Spinal Fusion; Tomography, X-Ray Computed; Treatment Outcome
Abstract
Most atlas fractures are the result of compression forces. They are often combined with fractures of the axis and especially with the odontoid process. Multiple classification systems for atlas fractures have been described. For an adequate diagnosis, a computed tomography is mandatory. To distinguish between stable and unstable atlas injury, it is necessary to evaluate the integrity of the transverse atlantal ligament (TAL) by magnetic resonance imaging and to classify the TAL lesion. Studies comparing conservative and operative management of unstable atlas fractures are unfortunately not available in the literature; neither are studies comparing different operative treatment strategies. Hence all treatment recommendations are based on low level evidence. Most of atlas fractures are stable and will be successfully managed by immobilization in a soft/hard collar. Unstable atlas fractures may be treated conservatively by halo-fixation, but nowadays more and more surgeons prefer surgery because of the potential discomfort and complications of halo-traction. Atlas fractures with a midsubstance ligamentous disruption of TAL or severe bony ligamentous avulsion can be treated by a C1/2 fusion. Unstable atlas fractures with moderate bony ligamentous avulsion may be treated by atlas osteosynthesis. Although the evidence for the different treatment strategies of atlas fractures is low, atlas osteosynthesis has the potential to change treatment philosophies. The reasons for this are described in this review.
Clinical Institute
Orthopedics & Sports Medicine
Clinical Institute
Neurosciences (Brain & Spine)
Specialty/Research Institute
Orthopedics
Specialty/Research Institute
Surgery
Specialty/Research Institute
Neurosciences
