Jefferson fracture

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Background

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

Vertebral fractures and dislocations types

Vertebral anatomy.

Numbering order of vertebrae.

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

Neck Trauma

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

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

References

↑ 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.
↑ 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.

Authors:

[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.

[1]

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