General Editor: Luiz Vialle

Authors: Ronald Lehman, Daniel Riew, Klaus Schnake

Occipitocervical trauma - ATLAS, Type I Occipitocervical fusion (screw fixation)

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1 Introduction top

Anterior arch fractures are stable in flexion but can displace in hyperextension, and should be immobilized in an orthosis until healed.

The purpose of a collar is to prevent ranges of motion outside of limits deemed unfavorable for fracture healing.

A fracture that is deemed to be stable may be treated with a collar immobilization or without immobilization.

Early mobilization is instituted once a patient is upright. AP lateral plain x-rays are then obtained to make sure there is no significant fracture displacement requiring surgery.

2 Options top


Soft collar

A soft collar will not provide any mechanical support and is only used for pain management.

Do not use for more than 2-3 weeks.


Hard collar PDC

This collar provides limited support for the upper cervical spine. Furthermore it can be used for additional support after surgery.

When used in treatment of stable fractures, x-ray control should be performed after 1 week.

The total treatment duration is typically 6 weeks. These collars have been shown to actually increase motion in the upper cervical spine when the patient is chewing. This is because the lower jaw is prevented from dropping so the only way for the patient to chew is by moving the head up and down.

v1.0 2016.12.01