Fractures of the first cervical vertebra are usually caused by indirect trauma with force being transmitted through the skull to the atlas. The clinical picture usually is of little help in making the diagnosis which depends on anteroposterior and lateral roentgenograms often supplemented by axial views and body section techniques. Congenital defects in the arches and other anomalies may confuse the diagnosis.

Symptomatic treatment of atlantal fractures with bracing and other external support almost always ends in a satisfactory result. Fractures of the axis, however, accompansy about one-third of atlantal fractures and in these cases the incidence of cervical cord and vertebral artery injury rises. Traction with tongs or a halter may be necessary to prevent cord injury and, if continued atlanto-axial instability threatens despite support in a Minerva jacket, occipitocervical fusion might be indicated.

While rupture of the vertebral artery is rare, symptoms and signs of basilar artery insufficiency should lead one to suspect an anteriovenous fistula of the vertebral artery at the level of the first cervical vertebra. This lesion might require vertebral artery arteriography and surgical repair.