Jefferson fracture

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Background

Clinical Features

  • Fracture of the anteterior and posterior arches[1]
    • Due to axial loading transmitted through occipital condyles to the lateral masses
  • Frequently associated with other cervical fractures
  • May be associated with vertebral artery injury[2]
Axial CT scan of Jefferson fracture
Odontoid View

Differential Diagnosis

Cervical Spine Fractures and Dislocations

Evaluation

  • 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

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

References

  1. Jefferson, G. (1919) ‘Fracture of the atlas vertebra. Report of four cases, and a review of those previously recorded’, British Journal of Surgery, 7(27), pp. 407–422.
  2. Muratsu H, Doita M, Yanagi T et-al. Cerebellar infarction resulting from vertebral artery occlusion associated with a Jefferson fracture. J Spinal Disord Tech. 2005;18 (3): 293-6.