Jefferson fracture

Background

• Also known as a C1 burst fracture
• No ligamentous disruption
• Is an unstable spine injury

Clinical Features

• Fx of the ant AND post arches
  • Due to axial loading transmitted through occipital condyles to the lateral masses

Axial CT scan of Jefferson fracture

Differential Diagnosis

Vertebral fractures and dislocations types

Vertebral anatomy.

Numbering order of vertebrae.

• Cervical fractures and dislocations
  • Atlanto-occipital dissociation
  • C1
    • Jefferson fracture
    • C1 isolated anterior arch fracture
    • C1 isolated posterior arch fracture
  • C2
    • Odontoid fracture
    • Hangman's fracture
  • C3-C7
    • Cervical burst fracture
    • Cervical spinous process fracture
    • Extension cervical teardrop fracture
    • Flexion cervical teardrop fracture
    • Anterior cervical wedge fracture
  • Cervical facet dislocation
  • Isolated transverse process fracture
• Thoracic and lumbar fractures and dislocations
  • Chance fracture
  • Thoracic burst fracture
  • Lumbar burst fracture
  • Isolated transverse process fracture
  • Thoracic and lumbar compression fractures

Workup

• Suspect disruption if:
  • Lateral x-ray: Increase in the predental space between C1 and dens (>3mm in adults, >5mm in children)
  • Odontoid x-ray: Masses of C1 lie lateral to outer margins of articular pillars of C2
  • If either of the above findings on x-ray obtain CT C-spine

Management

Prehospital Immobilization

See NAEMSP National Guidelines for Spinal Immobilization

Hospital

• Degree of instability determined by whether or not the transverse ligament is disrupted
• C-collar
• Consult ortho or spine as needed

Disposition

• Admit

See Also

• Spinal Cord Trauma
• Neurogenic Shock
• C-Spine X-Ray
• Unstable spine fractures
• Cervical spine injuries