Diagnosis and management of isolated C1 fractures: A systematic review
Objective: Atlas fractures are a common craniocervical injury, often resulting from trauma. However, diagnosis and management of atlas fractures continues to be the subject of controversy. We aimed to characterize the factors related to diagnosis of atlas fractures, delineate important consideration...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Journal of Craniovertebral Junction and Spine |
| Subjects: | |
| Online Access: | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2022;volume=13;issue=3;spage=233;epage=244;aulast=Chan |
| _version_ | 1811240567343939584 |
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| author | Kyle Samuel Chan Nathan A Shlobin Nader S Dahdaleh |
| author_facet | Kyle Samuel Chan Nathan A Shlobin Nader S Dahdaleh |
| author_sort | Kyle Samuel Chan |
| collection | DOAJ |
| description | Objective: Atlas fractures are a common craniocervical injury, often resulting from trauma. However, diagnosis and management of atlas fractures continues to be the subject of controversy. We aimed to characterize the factors related to diagnosis of atlas fractures, delineate important considerations in selecting the optimal management for a patient with an atlas fracture, and compare outcomes of surgical and conservative management.
Methods: We performed a systematic review using PubMed, Embase, and Scopus to identify articles that analyzed diagnosis and management of isolated atlas fractures published between 2013 and 2020. Titles and abstracts were screened. Studies meeting prespecified inclusion criteria were reviewed in full.
Results: Of 305 resultant articles, 13 were included. C1:C2 ratio and lateral mass displacement (LMD) were used to predict transverse atlantal ligament (TAL) injury. Surgery promoted high fusion rates overall. Stable atlas fractures achieved high fusion rates with conservative management, while spinal fusion promoted greater fusion rates than halo vest immobilization management for unstable fractures. Visual Analog Scale scores, range of motion, and/or LMD improved after surgery. LMD increased for unilateral sagittal split fractures with TAL injury after conservative treatment.
Conclusion: Stable atlas fractures can be sufficiently treated conservatively. Unstable atlas fractures can be managed both conservatively and surgically, while surgery is associated with favorable outcomes for unstable isolated atlas fractures. Future studies are necessary to further guide risk stratification and treatment approaches in management of the patients with isolated atlas fractures. |
| first_indexed | 2024-04-12T13:22:30Z |
| format | Article |
| id | doaj.art-099fef7d644a45d999497c4754707cd4 |
| institution | Directory Open Access Journal |
| issn | 0974-8237 |
| language | English |
| last_indexed | 2024-04-12T13:22:30Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Craniovertebral Junction and Spine |
| spelling | doaj.art-099fef7d644a45d999497c4754707cd42022-12-22T03:31:25ZengWolters Kluwer Medknow PublicationsJournal of Craniovertebral Junction and Spine0974-82372022-01-0113323324410.4103/jcvjs.jcvjs_61_22Diagnosis and management of isolated C1 fractures: A systematic reviewKyle Samuel ChanNathan A ShlobinNader S DahdalehObjective: Atlas fractures are a common craniocervical injury, often resulting from trauma. However, diagnosis and management of atlas fractures continues to be the subject of controversy. We aimed to characterize the factors related to diagnosis of atlas fractures, delineate important considerations in selecting the optimal management for a patient with an atlas fracture, and compare outcomes of surgical and conservative management. Methods: We performed a systematic review using PubMed, Embase, and Scopus to identify articles that analyzed diagnosis and management of isolated atlas fractures published between 2013 and 2020. Titles and abstracts were screened. Studies meeting prespecified inclusion criteria were reviewed in full. Results: Of 305 resultant articles, 13 were included. C1:C2 ratio and lateral mass displacement (LMD) were used to predict transverse atlantal ligament (TAL) injury. Surgery promoted high fusion rates overall. Stable atlas fractures achieved high fusion rates with conservative management, while spinal fusion promoted greater fusion rates than halo vest immobilization management for unstable fractures. Visual Analog Scale scores, range of motion, and/or LMD improved after surgery. LMD increased for unilateral sagittal split fractures with TAL injury after conservative treatment. Conclusion: Stable atlas fractures can be sufficiently treated conservatively. Unstable atlas fractures can be managed both conservatively and surgically, while surgery is associated with favorable outcomes for unstable isolated atlas fractures. Future studies are necessary to further guide risk stratification and treatment approaches in management of the patients with isolated atlas fractures.http://www.jcvjs.com/article.asp?issn=0974-8237;year=2022;volume=13;issue=3;spage=233;epage=244;aulast=Chanatlas fractureatlas fracturesc1 fracturec1 fractures |
| spellingShingle | Kyle Samuel Chan Nathan A Shlobin Nader S Dahdaleh Diagnosis and management of isolated C1 fractures: A systematic review Journal of Craniovertebral Junction and Spine atlas fracture atlas fractures c1 fracture c1 fractures |
| title | Diagnosis and management of isolated C1 fractures: A systematic review |
| title_full | Diagnosis and management of isolated C1 fractures: A systematic review |
| title_fullStr | Diagnosis and management of isolated C1 fractures: A systematic review |
| title_full_unstemmed | Diagnosis and management of isolated C1 fractures: A systematic review |
| title_short | Diagnosis and management of isolated C1 fractures: A systematic review |
| title_sort | diagnosis and management of isolated c1 fractures a systematic review |
| topic | atlas fracture atlas fractures c1 fracture c1 fractures |
| url | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2022;volume=13;issue=3;spage=233;epage=244;aulast=Chan |
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