C1 isolated posterior arch fracture

Background

• Stable cervical spine fracture
  • Anterior arch and transverse ligament are unaffected
• Also called a Landells Atlas Type I fracture
• Rule out burst fracture

Mechanism

• Due to forced neck extension

Differential Diagnosis

Cervical Spine Fractures and Dislocations

• Atlanto-occipital dissociation
• C1
  • Jefferson fracture
  • C1 isolated anterior arch fracture
  • C1 isolated posterior arch fracture
• C2
  • Odontoid fracture
  • Hangman's fracture
• C3-C7
  • Cervical burst fracture
  • Cervical spinous process fracture
  • Extension cervical teardrop fracture
  • Flexion cervical teardrop fracture
  • Anterior cervical wedge fracture
• Cervical facet dislocation

Imaging

• Vertical fracture line through posterior arch seen on lateral xray
• CT test of choice to eval for associated fx's
• MRI can evaluate ligamentous injury (transverse ligament is primary AA jxn stabilizer)

Management

• Hard collar for 6-12 weeks
  • Neurosurgery may prefer Halo immobilization
• Prehospital Immobilization see NAEMSP National Guidelines for Spinal Immobilization

Disposition

• Usually discharge (if truly isolated) in consultation with neurosurgery

See Also

• Cervical spine injuries
• C-Spine X-Ray
• C1 isolated anterior arch fracture
• Jefferson fracture

References

• Orthobullets

Authors

Ross Donaldson, Jonathan Osgood, Neil Young, Daniel Ostermayer