Atlas Fractures

These fractures account for 5-10% of all cervical spine injuries and 2% of all spine injuries. These are frequently seen in younger age groups and commonly result from motor vehicle accidents. In multiple trauma patients, they are usually associated with head injuries. They usually occur in combination with occipital condylar fractures or fractures of C2, such as dens fractures. A classification involving four types of fracture patterns has been described. These fractures involve the posterior arch, the lateral masses, Jefferson fractures and the horizontal fracture of the anterior arch (Fig. 22.3).

The posterior arch fractures are the most common. They are thought to occur due to a combination of hyperextension forces associated with axial loading. They can be seen in association with anterior teardrop hyperextension injuries of C2. An isolated fracture of this type can be treated safely in a cervical orthotic device for 8-12 weeks, since there is no disruption of the ligamentous structures. The union rates for this kind of injury are very high.

Axial loading associated with lateral bending results in a lateral mass fracture of C1. Usually identified in the open-mouth view, an asymmetry of the lateral masses of the atlas prompts further imaging by way of CT scanning. C2 and condylar fractures can also be better appreciated with CT. Lateral displacement of less than

2 mm usually indicates a stable injury, which can be safely treated with cervical orthosis.

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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