C1 anterior arch (plough) fracture
Neck pain post motor vehicle accident.
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There are vertical fractures involving the anterior arch of the atlas bilaterally with mild displacement of the fragmented bone anteriorly by 2 mm. No involvement of the posterior elements or lateral masses. Atlanto-occipital alignment is maintained.
A displaced segmental fracture of the anterior arch is rare and is referred to as a “plough” fracture. Forward thrust of the dens from hyperextension at the craniocervical junction acts to shear off the anterior arch of the C1, a mechanism that has been likened to a plough. This fracture is considered to be the bony equivalent of an atlas transverse ligament rupture and therefore is unstable.
Case co-author: Rehana Jaffer, MD, FRCPC
- A. Alex Mohit, James A. Schuster, Sohail K. Mirza, F. A. Mann. “Plough” Fracture: Shear Fracture of the Anterior Arch of the Atlas. (2012) American Journal of Roentgenology. 181 (3): 770. doi:10.2214/ajr.181.3.1810770 - Pubmed
- Gehweiler, John A., Raymond L. Osborne, and Roland Frederick Becker. The radiology of vertebral trauma. No. 16. WB Saunders Company, 1980.