{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T02:02:12Z","timestamp":1769047332382,"version":"3.49.0"},"reference-count":19,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2013,5,9]],"date-time":"2013-05-09T00:00:00Z","timestamp":1368057600000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2013,5]]},"abstract":"Objective<\/jats:title>The R<\/jats:styled-content>ule of S<\/jats:styled-content>pence states that displacement of the C1<\/jats:sub><\/jats:styled-content> lateral masses by >6.9\u20138.1\u2009mm suggests loss of transverse ligament integrity. The purpose of this study was to establish the thresholds of C1<\/jats:sub><\/jats:styled-content> displacement on CT <\/jats:styled-content>scans that correspond to transverse ligament disruption.<\/jats:p><\/jats:sec>Methods<\/jats:title>Over four years, consecutive patients with acute C1<\/jats:sub><\/jats:styled-content> fractures with at least three fracture lines were analyzed. CT<\/jats:styled-content> measurements and MRI<\/jats:styled-content> were assessed by blinded observers for bony displacement in the axial (internal and external lateral mass separation), coronal and sagittal planes and transverse ligament integrity.<\/jats:p><\/jats:sec>Results<\/jats:title>Eighteen patients were studied. Mean CT<\/jats:styled-content> bony measurements were as follows: internal border lateral mass separation (ILM<\/jats:styled-content>) 23.3 \u00b1 3.4\u2009mm, external border lateral mass separation (ELM<\/jats:styled-content>) 50.3 \u00b1 4.3\u2009mm, total C1<\/jats:sub><\/jats:styled-content> lateral mass overhang over the C2<\/jats:sub><\/jats:styled-content> superior process (LMO<\/jats:styled-content>) 5.4 \u00b1 1.3\u2009mm. Twelve patients were identified as having intact transverse ligament and six had transverse ligament disruption. There was no difference in mean normalized ILM<\/jats:styled-content>, ELM<\/jats:styled-content>, or LMO<\/jats:styled-content> between patients with or without transverse ligament integrity (P<\/jats:styled-content><\/jats:italic> > 0.05).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>There was no correlation between bony displacement and transverse ligament integrity. CT<\/jats:styled-content> scans post\u2010injury may not show the position of maximal displacement. If there is clinical concern about a possible transverse ligament injury, MRI<\/jats:styled-content> should be performed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.12034","type":"journal-article","created":{"date-parts":[[2013,5,9]],"date-time":"2013-05-09T10:30:21Z","timestamp":1368095421000},"page":"94-99","source":"Crossref","is-referenced-by-count":29,"title":["Does C1<\/sub><\/scp> Fracture Displacement Correlate with Transverse Ligament Integrity?"],"prefix":"10.1111","volume":"5","author":[{"given":"Kristen E","family":"Radcliff","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Rothman Institute Thomas Jefferson University Hospital Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcos A","family":"Sonagli","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Rothman Institute Thomas Jefferson University Hospital Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luciano M","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Rothman Institute Thomas Jefferson University Hospital Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gursukhman S","family":"Sidhu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Rothman Institute Thomas Jefferson University Hospital Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd J","family":"Albert","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Rothman Institute Thomas Jefferson University Hospital Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander R","family":"Vaccaro","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Rothman Institute Thomas 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