Is immobilization adequate treatment of unstable burst fractures of the atlas? A case report with long-term follow-up evaluation.
The biomechanics and roentgenographic anatomy of the unstable burst fracture of the atlas are well known. A few reports in the literature depict a bony avulsion of the transverse ligament associated with this fracture. However, all patients were treated surgically, so the natural course of this injury is undocumented--in other words, it is not known if the bony avulsion will heal. This is a case report of a 38-year-old woman with burst fracture of the atlas associated with a bony avulsion of the transverse ligament treated nonsurgically. At follow-up examination three years later, the bony fragment had not healed, and atlantoaxial instability persisted. Nonsurgical treatment of this injury may have a role, but surgical stabilization will usually be required after the posterior arch heals.
D000328:Adult; D002370:Casts, Surgical; D001270:Cervical Atlas / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008023:Ligaments, Articular / Q000293:injuries; D011859:Radiography; D014143:Traction