Gehweiler classification of atlas fractures

Last revised by Assoc Prof Craig Hacking on 11 Aug 2021

The Gehweiler classification of atlas fractures described 5 types of fractures of the atlas. In addition, Dickman classified injuries of the transverse atlantal ligament (a.k.a. transverse band of the cruciform ligament) which has been incorporated into this classification system.

  • type 1: fractures of the anterior arch
  • type 2: fractures of the posterior arch and are usually bilateral
  • type 3: fractures involving the anterior and posterior arch (Jefferson burst fracture)
    • type 3a: intact transverse atlantal ligament
    • type 3b: disrupted transverse atlantal ligament complex
      • Dickman type 1: ligamentous disruption
      • Dickman type 2: bony avulsion with an intact ligament transverse atlantal ligament
  • type 4: fractures of the lateral mass
  • type 5: isolated fractures of the C1 transverse process

The Rule of Spence has been advocated in the past as a radiographic method to assess for the integrity of the transverse atlantal ligament.

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Cases and figures

  • Figure 1: type 1
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  • Case 1: type 1
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  • Figure 2: type 2
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  • Case 2: type 2
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  • Figure 3: type 3a
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  • Case 3: type 3a
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  • Figure 4: type 3b (Dickman 1)
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  • Case 4: type 3b subtype 1
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  • Figure 4: type 3a (Dickman 2)
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  • Case 5: type 3b subtype 2
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  • Figure 5: type 4
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  • Case 6: type 4
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  • Figure 6: type 5
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  • Case 7: type 5
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