Study design: The authors report a case of an atlas fracture at the anterior arch.
Objective: To discuss the difficulty in diagnosing this type fracture.
Summary of background data: Fractures of the atlas are not uncommon, and actually constitute 10% of all cervical spine injuries in adults. However, in the pediatric population, fractures of atlas are extremely rare, and only a few cases have been described. Only two isolated anterior arcus fractures of the atlas have been reported previously.
Methods: A 2.5-year-old girl was admitted to the authors' department with neck pain and head tilt 2 days after falling from a wall onto the top of the head. Radiographs of the cervical spine reportedly showed no abnormality. Computed tomography of the upper cervical spine showed a fracture in left anterior arch of the C1 vertebra with a 2-mm separation. She was placed in a firm cervical collar and instructed to reduce her daily physical activities. A repeat scan 3 months later showed fusion at the fracture site.
Results: The patient was treated with a firm cervical collar, and fusion of the fracture site was documented with computed tomography scan at 12 weeks after the injury. Her cervical collar was removed, and she has been fully active with no restrictions.
Conclusions: On plain radiographs, fractures of the atlas and anterior aspect in particular may remain occult. Accurate diagnosis of atlas fractures depends on further radiologic investigations including computed tomography and magnetic resonance imaging. Experience in treating atlas fractures is insufficient because of a paucity of literature. Immobilization with a firm cervical collar is the treatment of choice in stable atlas fracture.