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Case of the Week 134. 10 year old boy with a history of trauma and neck pain. Does he have a new fracture of C1?. 3D CT scan, coronal image. Viewed anteriorly. Axial slice C1, bone window. Answer. Does he have a new fracture of the Atlas?
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Case of the Week 134 10 year old boy with a history of trauma and neck pain
Does he have a new fracture of C1? 3D CT scan, coronal image. Viewed anteriorly Axial slice C1, bone window
Answer • Does he have a new fracture of the Atlas? • No. This is a ‘split atlas’ (aka bipartite atlas) due to schisis defects of both the anterior and posterior arches. Smooth cortical bone obliterates the marrow cavity, indicating that this is not a fracture.
Clinical Significance • Anterior arch defects are very rare, occurring in approx 0.1% of the population. • In most cases anterior arch defects are associated with posterior arch defects as in this case. • Both of these anomalies are considered benign without associated instability. • They must be distinguished from acute Jefferson’s fractures in patients with axial trauma. CT is the imaging modality of choice to do this. • Reference: Kwon JK, et al. J Korean Neurosurg Soc 2009;46:522-527.
