In: Bucholz RW, Heckman JD, Court-Brown C, Tornetta P, Koval KJ, Wirth MA (eds) Rockwood and Green’s fractures in adults, 6th edn. AJR Am J Roentgenol 181:770īellabarba C, Mirza SK, Chapman JR (2005) Injuries of the craniocervical junction, Chapter 38. Mohit AA, Schuster JA, Mirza SK, Mann FA (2003) “Plough” fracture: shear fracture of the anterior arch of the atlas. Levine AM, Edwards CC (1991) Fractures of the atlas. Lippincott Williams & Wilkins, Philadelphia, PA In: Benzel EC (ed) The cervical spine, 5th edn. The present injury response data highlighted the role of load transfer from torso momentum to the upper cervical spine to produce anterior shear force and forward displacement of the dens and bony fragment of the anterior arch of the atlas relative to the C1 ring.ĭvorak MF, Street JT, Lenehan BJ (2012) Injuries to C1 and C2 (excluding odontoid fractures), Chapter 46. ![]() Our present results, though preliminary, indicate that plough fracture of the anterior arch of the atlas likely occurred immediately following or simultaneously with associated axis fractures at approximately 58 ms following impact to the upper forehead. Forward translation ended at 48 ms for the head and 72 ms for the C3 vertebra. Peak force occurred first at the impact barrier (1,903.0 N 47 ms) followed by the neck (1,715.9 N 58 ms). This specimen had an anteriorly displaced fracture fragment consisting of the inferior portion of the atlantal anterior arch together with multiple complete fractures of the axis. Horizontal velocity of C3 at the time of forehead impact was 2.7 m/s. ResultsĪ single specimen sustained a plough fracture variant to the atlantal anterior arch due to impact to the upper forehead and continued forward torso momentum. Time-history biomechanical responses were determined for neck loads, accelerations, and motions. Post-impact fluoroscopy and anatomical dissection documented the injuries. ![]() We divided 13 specimens into 3 groups based upon head-impact location: upper forehead in the midline, upper lateral side of the forehead, and upper lateral side of the head. Horizontally aligned head impacts into a padded barrier were simulated using a human upper cervical spine specimen (occiput through C3) mounted to a surrogate torso mass on a sled and carrying a surrogate head. ![]() Our objectives were to develop a biomechanical model to simulate atlantal plough fracture and investigate injury mechanisms. “Plough” fracture, in which the odontoid ploughs through and causes a high-energy shear fracture of the anterior arch of the atlas, has been documented in clinical case studies and classified as clinically unstable.
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