Gehweiler classification of atlas fractures
Citation, DOI, disclosures and article data
Citation:
Hacking C, Gaillard F, Deng F, et al. Gehweiler classification of atlas fractures. Reference article, Radiopaedia.org (Accessed on 14 Dec 2024) https://doi.org/10.53347/rID-86947
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rID:
86947
Article created:
Disclosures:
At the time the article was created Craig Hacking had no recorded disclosures.
View Craig Hacking's current disclosures
Last revised:
Disclosures:
At the time the article was last revised Frank Gaillard had no financial relationships to ineligible companies to disclose.
View Frank Gaillard's current disclosures
Revisions:
12 times, by
5 contributors -
see full revision history and disclosures
Systems:
Synonyms:
- Gehweiler's classification of atlas fractures
- Gehweiler classification (atlas fractures)
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.
Classification
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 transverse atlantal ligament
type 4: fractures of the lateral mass
type 5: isolated fractures of the C1 transverse process (rare)
The Rule of Spence has been advocated in the past as a radiographic method to assess for the integrity of the transverse atlantal ligament.
In a review of 189 fractures of the atlas, types 1 to 4 were all relatively evenly represented (type 1, 23.3%; type 2, 22.2%; type 3, 32.8%; type 4, 19.0%) whereas type 5 fractures are rare (1.1%) 5.
History and etymology
The system is named after John A Gehweiler, Jr, an American radiologist who described the sites of atlas fractures with colleagues from Duke University in 1976 in the journal Skeletal Radiology but the order was changed in later publications 4.
Quiz questions
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References
- 1. Laubach M, Pishnamaz M, Scholz M, Spiegl U, Sellei RM, Herren C, Hildebrand F, Kobbe P. Interobserver reliability of the Gehweiler classification and treatment strategies of isolated atlas fractures: an internet-based multicenter survey among spine surgeons. (2020) European journal of trauma and emergency surgery : official publication of the European Trauma Society. doi:10.1007/s00068-020-01494-y - Pubmed
- 2. Loren B. Mead, Paul W. Millhouse, Jonathan Krystal, Alexander R. Vaccaro. C1 fractures: a review of diagnoses, management options, and outcomes. (2016) Current Reviews in Musculoskeletal Medicine. 9 (3): 255. doi:10.1007/s12178-016-9356-5
- 3. Dickman CA, Greene KA, Sonntag VK. Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. (1996) Neurosurgery. 38 (1): 44-50. doi:10.1097/00006123-199601000-00012 - Pubmed
- 4. Gehweiler J, Duff D, Martinez S, Miller M, Clark W. Fractures of the Atlas Vertebra. Skeletal Radiol. 1976;1(2):97-102. doi:10.1007/bf00347414
- 5. Fiedler N, Spiegl U, Jarvers J, Josten C, Heyde C, Osterhoff G. Epidemiology and Management of Atlas Fractures. Eur Spine J. 2020;29(10):2477-83. doi:10.1007/s00586-020-06317-7 - Pubmed
Incoming Links
Articles:
Cases:
- Atlas (type 3b subtype 1) and axis (Anderson and D'Alonzo type 3, Roy-Camille type 2) fractures
- Occipital condyle fracture (type 1) and atlas transverse process fracture (type 5)
- Gehweiler classification of atlas fractures (diagrams)
- C1 anterior arch (plough) fracture - type 1
- Axis peg fracture (type 3) and atlas lateral mass (type 4) fracture
- Jefferson fracture
Multiple choice questions:
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