1. Home
  2. Skeleton
  3. Diagnosis
  4. Indications
  5. Treatment

Authors of section


Ronald Lehman, Daniel Riew, Klaus Schnake

General Editor

Luiz Vialle

Open all credits

C1 lateral masses osteosynthesis

1. Introduction

ATLAS osteosynthesis may be performed for type 3b fractures.

In order to avoid joint fusion C1-C2 or C0-C2 a direct approach can be performed stabilizing the lateral masses.

c1 lateral masses osteosynthesis

2. Approach and positioning

This procedure is performed through a posterior approach with the patient placed in the prone position.

posterior fixation

3. Screw insertion

Lateral mass screws are inserted bilaterally according to standard procedure.

The lateral masses may be more mobile than in an intact arch. The use of clamps or other types of support may be necessary the prevent movement of the lateral mass during screw insertion.

c1 lateral mass screws

4. Reduction

The screw extensions are used as joysticks to reduce the fracture.

c1 lateral masses osteosynthesis

Once satisfactory reduction is achieved, a connecting rod is installed between the screws to secure the reduction.

c1 lateral masses osteosynthesis

Slight compression is applied to ensure anatomical reduction.

c1 lateral masses osteosynthesis

5. Fixation

Screws are tightened to secure the reduction.

atlas type iiib

6. Aftercare

Patients are made to sit up in the bed on the evening following the operation.

A collar is commonly used following surgical stabilization to moderate patient activity.

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

Patients with intact neurological status are made to stand and walk on the first day after surgery. Patients can be discharged when medically stable or sent to a rehabilitation center if further care is necessary. This depends on the comfort levels and presence of other associated injuries.

Patients are generally followed with periodical x-rays at 6 weeks, 3 months, 6 months, and 1 year.