A review of fractures of the atlas vertebra.

From 48 consecutive cases of atlas fractures presenting over a 12.5-year period, two groups are apparent that differ in age, presentation, mechanism of injury, and treatment given. Jefferson fractures were, on average, 42 years of age. Displaced Jefferson fractures were treated by traction. At final review, those that had been reduced and those that were initially undisplaced did better than the displaced group. Inadequate reduction was often obtained due to insufficient traction. Patients sustaining a posterior arch fracture were generally more elderly and were, on average, 17 years older than those with a Jefferson fracture. Patients with a posterior arch fracture had marked degenerative changes in the mid- to distal cervical spine and almost invariably had another cervical spine fracture. Treatment was usually directed to the other cervical spine injury. Injury in the elderly usually followed low velocity trauma.