title: Solitary C1 Posterior Fixation for Unstable Isolated Atlas Fractures: Case Report and Systematic Review of the Literature.
abstract: Study Design A systematic review of the literature. Objectives To review the published results to date of motion-preserving direct reconstruction of C1 ring fractures with combined coronal plane displacement of at least 7 mm (rule of Spence) and so at risk for Dickman type I or II disruption of the transverse atlantal ligament (TAL). Methods A structured literature review prompted by successful management of a typical case. Results To date only 65 such cases are reported and follow-up is almost uniformly short. Although reported clinical success is uniform, the case mix is heterogenous and confirmation/classification of ligamentous injury at baseline is often lacking. Conclusions Direct C1 stabilization shows promise as a "more selective" option in managing displaced atlas fractures with probable TAL disruption but cannot yet be recommended as a practice standard. Prospective clinical studies are indicated and should be structured so as to differentiate between Dickman type I and type II injuries of the TAL.
authors.affiliation: Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Drew A
authors.initials: DA
authors.lastname: Bednar
authors.affiliation: Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Khaled A
authors.initials: KA
authors.lastname: Almansoori
keywords: atlas; displacement; fracture; instability; transverse atlantal ligament