title: C1 fracture in a patient with a congenital cleft in the posterior arch: report on a failed conservative treatment.
abstract: Unstable burst fractures of the atlas require sufficient immobilisation either with an external device or by surgical fusion. In patients with pre-existing congenital atlantal defects the decision whether to recommend non-operative or operative therapy is difficult. Treatment options are controversially discussed and standardised guidelines are not available. Although most surgeons advise operative fusion or osteosynthesis in atlanto-axial instability, non-operative immobilisation can be successful. We report on a patient with an unstable C1 burst fracture with a congenital posterior cleft in the atlantal arch who was treated with cervical extension and halovest immobilisation. Although callus bridging was initially observed, 9 months after the injury there was no sufficient fracture consolidation and surgical fusion had to be advised. While non-operative treatment may work in patients without congenital defects of the C1 arch, such is not recommended in patients who present with this anomaly.
authors.affiliation: Department of Shoulder Surgery, Rhoen Klinikum AG, Bad Neustadt, Germany. robert@hudek.de
authors.forename: Robert
authors.initials: R
authors.lastname: Hudek
authors.forename: Guido
authors.initials: G
authors.lastname: Wanner
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Simmen
authors.forename: Clément M L
authors.initials: CM
authors.lastname: Werner
mesh_terms: D000328:Adult; D001270:Cervical Atlas / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000293:injuries*; D000013:Congenital Abnormalities / Q000628:therapy*; D006801:Humans; D008297:Male; D016103:Spinal Fractures / Q000150:complications / Q000628:therapy*; D014057:Tomography, X-Ray Computed