Jefferson fracture

Background

• Also known as a C1 burst fracture
• 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

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