From the Guidelines
For a C1 (atlas) fracture, the Aspen collar is the best cervical collar option, as it provides excellent immobilization of the upper cervical spine, although the most recent evidence suggests that the type of collar used may not be as critical as previously thought, and the focus should be on minimizing cervical spine movement during airway management 1. The choice of cervical collar depends on the specific fracture pattern, stability assessment, and neurological status.
- Treatment duration typically ranges from 8-12 weeks, with regular radiographic follow-up to assess healing.
- During this period, patients should avoid activities that could stress the neck and follow proper collar care instructions, including keeping the skin clean and dry to prevent skin breakdown.
- The goal of immobilization is to allow the fracture to heal while maintaining proper alignment and preventing further injury to the spinal cord or vertebral arteries, which are particularly vulnerable with C1 fractures due to their anatomical relationship with this vertebra.
- According to the most recent guidelines, during tracheal intubation attempts, a semi-rigid or rigid cervical collar should be removed, which can be done most easily by only removing the anterior part of the collar; this will also help minimise any movement to the cervical spine 1.
- It is also recommended to use videolaryngoscopy for tracheal intubation in patients with suspected or confirmed cervical spine injury, as it can help reduce cervical spine movement 1.
- Clinicians should consider using an adjunct such as a stylet or bougie when performing tracheal intubation in a patient whose cervical spine is immobilised 1.
- Multidisciplinary planning, preparation, and optimisation of human factors should be considered before airway management in patients with suspected or confirmed cervical spine injury 1.
From the Research
C1 Fracture Treatment Options
The treatment of C1 fractures, also known as Jefferson fractures, can be managed with various cervical collars. The choice of collar depends on the stability of the fracture and the presence of other cervical injuries.
Rigid Cervical Collars
- The Miami-J collar is a rigid cervical collar that has been shown to be effective in treating stable Jefferson fractures 2.
- A study published in Spine found that 12 patients with stable Jefferson fractures treated with a Miami-J collar alone for 10 to 12 weeks showed no instability on follow-up plain radiographs 2.
- Another study published in The Journal of trauma compared the stabilizing effects of different orthoses, including the Miami J collar, and found that it provided moderate control in the sagittal plane and good control of "torque" in the upper cervical spine 3.
Other Treatment Options
- Halo immobilization is also a common treatment option for cervical spine fractures, including C1 fractures 4, 5.
- A study published in Yonsei medical journal found that halo-vest immobilization had a healing rate of 60.9% for upper cervical fractures, but was associated with a high complication rate of 60.9% 4.
- A retrospective study published in Global spine journal found that halo immobilization resulted in clinical success in 81% of patients with cervical spine fractures, but was associated with a complication rate of 46.3% 5.
Comparison of Treatment Options
- The choice of treatment option depends on the individual patient's condition and the stability of the fracture.
- Rigid cervical collars, such as the Miami-J collar, may be suitable for stable Jefferson fractures, while halo immobilization may be necessary for more unstable fractures or those with concurrent injuries 2, 4, 5.