General considerations
Type A1 fractures involve one single endplate and are in general treated nonoperatively.
Pay attention to the posterior ligaments to avoid misdiagnosing a type B2 fractures as an A1 fracture.
| Nonoperative (collars) | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Small wedge fracture; unconscious patient |  |
 |
Indications:
- Small wedge fractures
- Unconscious patients
Contraindications:
- Burns or other skin lesions
| Nonoperative (halo vest) | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Only indicated in selected cases |  |
 |
The use of a halo vest should be avoided for simple A1 fractures. It is only indicated in rare cases.
Indications
- Need of stabilization but anterior fixation is not possible
Contraindications
- Obese patients
- Spinal cord injury
- Polytrauma
- Fractures or soft tissue injuries of the skull
- Serious osteoporosis
Disadvantages
- Patient compliance needed
- Greatly uncomfortable
- Frequent follow up
- Difficult to maintain personal hygiene
| Anterior plating | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Severe wedging; polytrauma; SCI |  |
 |
Indication:
- Severe wedging
- Polytrauma
- Spinal cord injury
Contraindications
- General surgical contraindications
| *Skill | |
|---|---|
|
Basic surgical experience, no specialized skills |
|
Some specialized surgical experience |
|
Highly experienced and skilled surgeon |
| *Equipment | |
|---|---|
|
Basic equipment only |
|
Simple surgical and imaging resources |
|
Full specialized surgical and imaging resources |