Treatment of Cervical Spine Fractures

• C0
  • Stable
    • Cervical Orthosis
      
  • Unstable
    • C0 – C1/2 Fusion
• Atlanto occipital dissociation
  • Powers ratio
    
  • Wackenheim Line
  • Beware Traction
    
  • Halo
    
  • C0 C2 fusion
• C1 Fracture – Axial load
  • Jefferson with 4 part fracture
  • 6.8mm combined lateral mass overhang
    
  • Halo. Late instability = fusion
• C1/C2 Transverse lig rupture
  
  • AADI >3.5 mm
    
  • Traction in extension followed by fusion
• C2 Fractures
  • Dens
    
    • I Tip – look for C0 C1 dissociation
      
    • II base
      • nondisplaced – Halo
        
      • Displaced – ORIF – screw or posterior fusion C1/2
        
    • III Metaphyseal extension
      • <6mm displacement – HALO
        
      • >6mm C1/2 fusion
  • Hangman
    • Type 1 <3mm – cervical orthosis
      
    • Type 2 >3mm – displacement – Halo

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.