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Jefferson Fracture
From WikiSM
Contents
Other Names
- C1 Burst Fracture
- C1 Anterior Arch Fracture
- C1 Posterior Arch Fracture
Background
- This page describes traumatic C1 burst fracture, known more commonly as a 'Jefferson Fracture'
- Also covers isolated anterior and posterior arch fractures
History
- First reported by British Neurosurgery Sir Geoffrey Jefferson in 1920
Epidemiology
- C1 fractures account for:
- 25% of the upper cervical spine injuries[1]
- 2%–13% of all acute cervical spine fractures
- 1%–2% of all fractures of the human spinal column
- Males represent 57-69% of cases[2]
- Bimodal distribution: young men (20s) and elderly females (80s)[3]
- Mean age at diagnosis is 50,
Pathophysiology
- Typically seen after an axial load to the upper cervical spine and skull
- Less commonly seen with rotational forces
- Considered unstable due to tears to the transverse atlantal ligament
- By definition, both the anterior and posterior atlas rings are fractured
- Generally not associated with neuro deficits, fragments tend to spread away from spinal canal
Etiology
- Most commonly due to diving in a shallow body of water, falling or motor vehicle accident
Pathoanatomy
- C1 (also known as atlas)
- No vertebral body, instead has anterior and posterior arches
- Sits bellow the occiput and above C2, articulating with both
- Vertebral arteries pass through the transverse foramina
- Transverse atlantal ligament (TAL)
- Rupture of ligament compromises atlantodens relationship
Associated Injuries
Risk Factors
- Unknown
Differential Diagnosis
- Fractures
- Subluxations and Dislocations
- Neuropathic
- Muscle and Tendon
- Pediatric/ Congenital
- Other Etiologies
Clinical Features
- General: Physical Exam Neck
- History
- Often a history of significant trauma with axial load, flexion or extension mechanism
- Patients will endorse neck pain
- Neurologic symptoms frequently absent
- Physical Exam
- Avoid range of motion
- Thorough neurovascular exam of extremities
Evaluation
Radiographs
- Standard cervical radiographs are rarely helpful
- Difficult to see C1 fractures on plain films
- May demonstrate
- Ligamentous instability inferred with lateral mass displacement of 7 mm or greater
- Increased atlanto-dens interval (ADI)
CT
- Gold standard for osseus evaluation
MRI
- Useful to evaluate soft tissue and ligamentous injury
Pediatric Considerations
- Challenging diagnostically in young children
- C1 body not radiographically visible until age 1[4]
- Does not fuse until age 4
- Congenital abnormalities can also cloud the picture
Classification
- Type I
- Axial load and flexion or extension
- Isolated fracture of the anterior or posterior arch
- Type II
- Axial load
- Bilateral fractures of anterior and posterior arch
- Type III
- Axial load and rotation
- Lateral mass fracture
Management
- No standardized management guidelines
- Recommendations based on case reports and case series
Prognosis
- Needs to be updated
Nonoperative
- Indications
- Stable fracture
- First line in most cases
- Technique
- Rigid collar
- Halo-thoracic brace
- Sterno-occipitomandibular immobilization
- Minerva Jacket
- Immobilize for 8-12 weeks
Operative
- Indications
- Complex fracture patterns
- Co-occuring C2 fracture, atlanto-occipital dislocation
- Instability
- Neurologic compromise
- Technique
- Occiput-C1 or C1-C2 fusion
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play
- Needs to be updated
Complications
- Myelopathy
- Death
- Nonoperative
- Neck Pain
- Discomfort from orthosis
- Surgical
- Infection
- Hardware displacement
- Cock-robin deformity (atlantoaxial rotatory fixation)
See Also
- Internal
- External
- Sports Medicine Review Neck Pain: https://www.sportsmedreview.com/by-joint/neck/
References
- ↑ Levine AM, Edwards CC. Fractures of the atlas. J Bone Joint Surg Am. 1991;73:680–91.
- ↑ Matthiessen C, Yohan R. Epidemiology of atlas fractures—a national registry-based cohort study of 1,537 cases. Spine J. 2015;15(11):2332–7.
- ↑ Kakarla UK, Chang SW, Theodore N, Sonntag VK. Atlas fractures. Neurosurgery. 2010;66(3 Suppl):60–7.
- ↑ Lee C, Woodring JH. Unstable Jefferson variant atlas fractures: an unrecognized cervical injury. AJNR Am J Neuroradiol. 1991;12(6):1105–10