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Biomechanical Analysis of Atlas Fractures: A Study on 40 Human Atlas Specimens

Gebauer, Matthias, MD*†; Goetzen, Nils; Barvencik, Florian, MD*†; Beil, Frank Timo, MD*†; Rupprecht, Martin, MD*†; Rueger, Johannes M., MD*†; Püschel, Klaus, MD§; Morlock, Michael, PhD; Amling, Michael, MD*†

doi: 10.1097/BRS.0b013e31816956de

Study Design. Forty isolated specimens of the first cervical vertebra were tested by the application of pure axial force to failure. To exclude ligamentous side effects, transverse ligaments were dissected in all specimens.

Objective. To investigate the biomechanical characteristics of the human atlas and to describe the influence of different speeds of force impact on the fracture types.

Summary of Background Data. Atlas fractures have been reproduced in some studies in the literature. However, the characteristics of isolated atlas fractures under pure axial loading at different speeds has not been reported so far.

Methods. After dissection of soft tissue and generation of a peripheral quantitative computed tomography scan, the atlas preparations were tested to failure by displacement-controlled axial force application at constant speeds of either 0.5 mm/s (Group 1) or 300 mm/s (Group 2). The fracture types were classified according to Gehweiler.

Results. At slow loading speed (Group 1), 2 Type-I (anterior arch), 3 Type-II (posterior arch), 2 Type-III (anterior and posterior arch), and 13 Type-IV (lateral mass) fractures occurred out of 20 specimens. At high loading speed (Group 2), Type-III fractures (burst fractures of 2 to 4 parts) occurred in all 20 tested specimens.

Conclusion. The presented results strongly suggest that the Type of atlas fracture depends on the speed of axial force impact. The present study demonstrates that Type-III fractures (2- to 4-part burst fractures) result from fast force impact whereas slow force impact is responsible for Type-IV atlas fractures of the lateral mass.

Forty human atlas preparations were tested to failure by axial force application at constant speeds of either 0.5 or 300 mm/s. At high loading speed in all 20 tested specimens Type-III fractures (burst fractures) occurred. Slow force impact mainly resulted in Type-IV fractures of the lateral mass.

From the *Center for Biomechanics and Skeletal Biology UKE; †Department of Trauma-, Hand-, and Reconstructive Surgery; ‡Institute for Biomechanics, Hamburg University of Technology, Hamburg; and §Department of Forensic Medicine, University Medical Center Hamburg-Eppendorf, Germany.

Acknowledgment date: June 26, 2007. Revision date: October 14, 2007. Acceptance date: October 16, 2007.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

M.G. and N.G. contributed equally to this study and therefore share first authorship.

Address correspondence and reprint requests to Michael Amling, MD, Center for Biomechanics and Skeletal Biology, Department of Trauma-, Hand-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.