C1 (Atlas) Fractures Clinical Presentation

Updated: Apr 07, 2022
  • Author: J Allan Goodrich, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
  • Print

History and Physical Examination

Patients with C1 (atlas) fractures customarily present with a history of trauma and a symptom of pain in the neck. Among the massive number of patients who qualify as having this history and symptom, a few patients have an unstable C1 injury and may present in a neurologically intact state, but they are at grave risk for neurologic compromise if not promptly diagnosed and appropriately stabilized and treated.

Patients with a complete spinal cord injury (SCI) and no neurologic function continue to have only sensation on the face and motor control of the facial muscles from the cranial nerves. A tracheostomy is essential; the patient requires respiratory assistance and a volume respirator. If the C3-C5 area is intact, the phrenic nerve may often be stimulated to contract the diaphragm. If stimulation of the phrenic nerve does not contract the diaphragm, then the spinal cord is no longer functioning; the cell body is dead, and a phrenic electrical stimulator is not effective.



The Gehweiler classification is commonly used to categorize C1 fractures. This sytem divides fractures of the atlas into the following five types [14]

  • Type I - Fracture of the anterior arch
  • Type II - Fracture of the posterior arch
  • Type IIIa/ IIIb - Combined fracture of both the anterior and the posterior arch (Jefferson fracture), either nondisplaced (IIIa) or displaced (IIIb) 
  • Type IV - Fracture of the massa lateralis
  • Type V - Fracture of the transverse process