Related Experiment Video
Updated: Jun 2, 2026
A Contusive Model of Unilateral Cervical Spinal Cord Injury Using the Infinite Horizon Impactor
Published on: July 24, 2012
Horizontal C-1 fractures in association with unstable distraction injuries of the craniocervical junction
Marcelo D Vilela1, Richard J Bransford, Carlo Bellabarba
1Department of Neurological Surgery, University of Washington, Seattle, Washington, USA. mdvilela@u.washington.edu
Insights
Horizontal fractures of the atlas (C-1) can indicate severe, unstable craniocervical junction injuries, not just benign fractures. This finding necessitates further evaluation for associated severe trauma.
Area of Science:
- Orthopedic Surgery
- Neurosurgery
- Radiology
Background:
- Horizontal fractures of the atlas anterior arch were historically considered stable.
- These fractures were typically treated non-operatively with cervical collars.
Purpose of the Study:
- To investigate the association between C-1 horizontal fractures and severe craniocervical distraction injuries.
- To challenge the notion that C-1 horizontal fractures are always benign.
Main Methods:
- Retrospective review of imaging studies from 1995-2009.
- Inclusion of surviving patients with diagnosed unstable craniocervical distraction injuries requiring surgery.
- Specific focus on patients with concomitant C-1 horizontal fractures.
Main Results:
- Five out of 47 patients with unstable craniocervical distraction injuries presented with a C-1 horizontal fracture.
- One patient had a C1-2 distractive injury.
- Four patients exhibited occipitoatlantal dissociation, a grossly unstable injury.
Conclusions:
- A C-1 horizontal fracture is not always indicative of a benign injury.
- The presence of a C-1 horizontal fracture should raise suspicion for a more severe, unstable craniocervical junction injury.
- Further investigation is warranted when a C-1 horizontal fracture is identified.
Object:
Horizontal fractures of the anterior arch of the atlas not associated with odontoid fractures have been regarded as stable fractures that can be simply treated with a cervical collar. The authors report that C-1 horizontal fractures also occur in association with severe distraction injuries of the craniocervical junction.
Methods:
The authors retrospectively reviewed imaging studies obtained in all surviving patients in whom unstable distraction injuries of the craniocervical junction were diagnosed and in whom surgery was performed at their institution between 1995 and 2009. All patients who also had a C-1 horizontal fracture as a component of their spinal injury were included in the study.
Results:
Of 47 patients with unstable craniocervical distraction injuries, 5 patients had a horizontal fracture through the anterior ring of C-1: 1 patient had a primarily C1-2 distractive injury whereas 4 others had a grossly unstable injury across the occipitoatlantal junction (occipitoatlantal dissociation).
Conclusions:
The finding of a C-1 horizontal fracture does not always reflect a benign injury and its presence should heighten the concern of a more severe and unstable injury at the craniocervical junction.
Related Concept Videos
01:14Spinal Cord Injury ll: Pathophysiology
01:28Articulations of the Vertebral Column
01:29Herniated Intervertebral Disc l: Introduction
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the procedure...
01:24Flail Chest-I
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
01:14Increased Intracranial Pressure l: Introduction