Atlas fracture

Introduction to atlas fracture Axillary fracture and dislocation is a common type of upper cervical spine injury, accounting for about 50%. Clinically seen fractures and dislocations of the atlas, the neurological symptoms are different, some died on the spot, some cases are serious, with varying degrees Brainstem and spinal cord high-level injury, manifested as cranial nerve spasm, quadriplegia or insufficiency and respiratory disorders, often need immediate assisted breathing, and some are only occipital neck pain and movement disorders, neurological symptoms are mild, but these patients still It is potentially dangerous and should be given high priority and corresponding treatment. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: spinal cord injury

Causes of atlas fracture

The disease occurs when an object falling from a height hits the top of the head, or falls from a height, and the top of the head touches the ground vertically. The atlas is connected to the occipital bone and other cervical vertebrae. It is an atypical spine with an elliptical shape and no vertebral body. It is thickened and thickened on both sides of the ring. It is called the lateral block, and its upper and lower surfaces are obliquely inward and forward. surface. The anterior and posterior vertebral arches protruding from the lateral block are the weakest part of the atlas and are the most common fracture sites. When the accumulation of violence and reaction forces on the atlas, due to the introversion of the superior and inferior articular surfaces of the atlas, the combined force of violence and reaction forces causes the sacral vertebral block to undergo eccentric violent violence, thereby connecting the anterior and posterior arch of the atlas to the lateral block. The weakest part of the fracture, also known as the Jefferson fracture. It is characterized by four fractures of the atlas fracture, forming four fracture segments, namely two lateral blocks and two front and rear arches. When the direction of violence is not correct, only on the side of the head or when the head tends to be violent, it can cause a vertebral arch fracture and occasionally cause a lateral block fracture.

Prevention of atlas fracture

1. Strengthen nutrition and exercise, try to delay the aging process and reduce the degree of aging. Older people should eat more foods rich in protein and vitamin D. Frequent outdoor activities, exposure to sunlight, promote the body to synthesize more vitamin D, and assist in the absorption of calcium to facilitate the renewal of bone components. In addition, be careful not to smoke, in order to prevent the absorption of calcium.

2. Strengthen the care of the elderly. Try not to let older people live alone. Older, out-of-town activities should be accompanied. Increase indoor temperature and reduce dressing to prevent excessive swelling and affect activities. There is a choice of shoes to wear, and hard plastic shoes are the most unsuitable. The floor of the room, especially the toilet floor, should be kept dry to prevent water accumulation and freezing. Use crutches as appropriate.

3. Control weight, avoid excessive obesity, and timely treat related diseases. Attention to drugs commonly used in the elderly, such as blood pressure lowering drugs, can cause positional hypotension, leading to falls. Too much drinking, often resulting in imbalance, need to be controlled. Once you fall, you should seriously ask and check for damage after lifting. If the pain is heavier, local swelling, deformity, inability to move, should be suspected of fracture or dislocation, should be simply fixed near the nearest material, and then sent to the hospital for examination, X-ray film to help diagnose, correct treatment.

Complications of atlas fracture Complications spinal cord injury

Often complicated by complete or incomplete spinal cord injury.

Symptoms of atlas fractures Common symptoms Coma head and neck activity restricted neck instability subcutaneous hematoma ligament rupture

The neck is sore and stiff, and the patient often holds the head with both hands to avoid their activities. For example, when the second cervical nerve is involved (the occipital nerve is involved, the patient feels occipital pain, cervical tendon, and neck activity is limited. If the spinal cord is injured, there may be a loss of motor sensation. If the injury is serious, it may cause paralysis or even death immediately.

Examination of atlas fracture

X-ray film

Should include the right position, lateral position and opening position, the lateral position can show the anteroposterior diameter of the atlas; the opening position can be found that the left and right widening of the atlas is wide, and the distance from the odontoid is often asymmetric on both sides, such as bilateral If the total lateral displacement exceeds 7 mm, it means that the transverse ligament of the atlas is broken, which may cause accidents. It should be noted (Fig. 4).

2. CT examination

The number of fracture lines, the direction of the fracture line and the displacement of the bone block can be clearly displayed.

3. MRI examination

The observation of the fracture is not as clear as the former, and is mainly used for patients with spinal cord symptoms, and is conducive to the determination of the transverse ligament rupture of the atlas.

Diagnosis and diagnosis of atlas fracture

Diagnostic criteria

History of trauma

In addition to obtaining a history of trauma directly from the inquiry, the coma can be inferred from the head and neck with or without skin contusion or subcutaneous hematoma and the characteristics of head injury.

2. Clinical features

As mentioned above, in addition to the symptoms of spinal cord injury, it is mainly the local symptoms of the cervical vertebrae at the posterior occipital neck.

3. Imaging examination

(1) X-ray plain film: should include the positive position, lateral position and opening position. The lateral position can show the anteroposterior diameter of the atlas. The opening position can be found that the left and right widening of the atlas is wide, and the distance from the odontoid is often bilateral. Asymmetric shape, such as the total bilateral displacement of more than 7mm, it indicates that the transverse ligament of the atlas is broken, which is easy to cause accidents, should pay attention to (Figure 4).

(2) CT examination: the number of fracture lines, the direction of the fracture line and the displacement of the bone block can be clearly displayed.

(3) MRI examination: the observation of the fracture is not as clear as the former, mainly used for those with spinal cord symptoms, and is conducive to the determination of the transverse ligament rupture of the atlas.

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