Executive Editor: Luiz Vialle

Subaxial cervical trauma - A1

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Glossary

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 Basic surgical experience, no specialized skills Basic equipment only

Indications:

  • Small wedge fractures
  • Unconscious patients

Contraindications:

  • Burns or other skin lesions
Nonoperative (halo vest)
Main indication Skill Equipment
Only indicated in selected cases Some specialized surgical experience Simple surgical and imaging resources

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 Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Indication:

  • Severe wedging
  • Polytrauma
  • Spinal cord injury

Contraindications

  • General surgical contraindications
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources