{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:10:08Z","timestamp":1756368608334,"version":"3.44.0"},"reference-count":37,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>Unstable burst fractures of the atlas require sufficient immobilisation either with an external device or by surgical fusion. In patients with pre-existing congenital atlantal defects the decision whether to recommend non-operative or operative therapy is difficult. Treatment options are controversially discussed and standardised guidelines are not available. Although most surgeons advise operative fusion or osteosynthesis in atlanto-axial instability, non-operative immobilisation can be successful. We report on a patient with an unstable C1 burst fracture with a congenital posterior cleft in the atlantal arch who was treated with cervical extension and halovest immobilisation. Although callus bridging was initially observed, 9\u2005months after the injury there was no sufficient fracture consolidation and surgical fusion had to be advised. While non-operative treatment may work in patients without congenital defects of the C1 arch, such is not recommended in patients who present with this anomaly.<\/jats:p>","DOI":"10.1136\/bcr-2013-008872","type":"journal-article","created":{"date-parts":[[2013,6,14]],"date-time":"2013-06-14T03:12:21Z","timestamp":1371179541000},"page":"bcr2013008872","source":"Crossref","is-referenced-by-count":3,"title":["C1 fracture in a patient with a congenital cleft in the posterior arch: report on a failed conservative treatment"],"prefix":"10.1136","volume":"2013","author":[{"given":"Robert","family":"Hudek","sequence":"first","affiliation":[{"name":"Department of Shoulder Surgery, Rhoen Klinikum AG, Bad Neustadt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guido","family":"Wanner","sequence":"additional","affiliation":[{"name":"Department of Traumatology, University Hospital Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans-Peter","family":"Simmen","sequence":"additional","affiliation":[{"name":"Department of Traumatology, University Hospital Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cl\u00e9ment M L","family":"Werner","sequence":"additional","affiliation":[{"name":"Department of Traumatology, University Hospital Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,6,13]]},"reference":[{"key":"2025082800510659000_2013.jun13_1.bcr2013008872.1","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/BF00347414","article-title":"Fractures of the atlas vertebra","volume":"2013","author":"Gehweiler","year":"1976","journal-title":"Skeletal Radiol"},{"key":"2025082800510659000_2013.jun13_1.bcr2013008872.2","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1148\/130.1.77","article-title":"Cervical spine trauma: the common combined conditions","volume":"2013","author":"Gehweiler","year":"1979","journal-title":"Radiology"},{"key":"2025082800510659000_2013.jun13_1.bcr2013008872.3","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0030-5898(20)30416-8","article-title":"Treatment of injuries in the C1-C2 complex","volume":"2013","author":"Levine","year":"1986","journal-title":"Orthop Clin North Am"},{"key":"2025082800510659000_2013.jun13_1.bcr2013008872.4","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1227\/00006123-198807000-00007","article-title":"Acute traumatic atlas fractures: management and long term outcome","volume":"2013","author":"Hadley","year":"1988","journal-title":"Neurosurgery"},{"key":"2025082800510659000_2013.jun13_1.bcr2013008872.5","first-page":"3","article-title":"The significance of abnormalities of the cervical spine","volume":"2013","author":"McRae DL","year":"1960","journal-title":"AJR"},{"key":"2025082800510659000_2013.jun13_1.bcr2013008872.6","first-page":"819","article-title":"[Congenital abnormalities of the arcs of the atlas]","volume":"2013","author":"Desgrez","year":"1965","journal-title":"J Radiol Electrol Med Nucl"},{"key":"2025082800510659000_2013.jun13_1.bcr2013008872.7","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1007\/BF00404112","article-title":"Fracture of the anterior arch of the atlas associated with a congenital cleft of the posterior arch. 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