Unilateral avulsion fracture of the transverse atlantal ligament: successful treatment in a rigid cervical collar.

A 34-year-old male sustained a unilateral avulsion fracture through the origin of the transverse atlantal ligament following a road traffic accident. This was successfully treated in a rigid neck collar for 8 weeks. Injuries to the transverse atlantal ligament are often associated with significant bony injury and atlanto-axial instability. Isolated injuries to the transverse ligament are extremely rare and the present case suggests that a trial of conservative management may be worth pursuing.