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
Vertebral fractures and dislocations types
- Cervical fractures and dislocations
- Thoracic and lumbar fractures and dislocations
Clinical Features
- Due to forced neck extension
Differential Diagnosis
Neck Trauma
- Penetrating neck trauma
- Blunt neck trauma
- Cervical injury
- Neurogenic shock
- Spinal cord injury
Diagnosis
- Vertical fracture line through posterior arch seen on lateral x-ray
- CT test of choice to evaluate for associated fractures
- MRI can evaluate ligamentous injury (transverse ligament is primary AA junction 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