Once identified, atlas fractures can be classified by the fracture pattern table table1. Overview casting is standard treatment for many closed, nondisplaced, or reduced fractures. Type i fractures are isolated to the anterior or posterior arch, a rare injury with intact transverse ligament. A jefferson fracture is a bone fracture of the anterior and posterior arches of the c1 vertebra, though it may also appear as a three or twopart fracture. For isolated fractures of the atlas with disruption of the transverse atlantal ligament, either cervical immobilization alone or surgical fixation and fusion is recommended. The last image is a ct axial view, which clearly shows the. This case report discusses the fixation of a jefferson fracture using c1 lateral mass screws to achieve surgical stabilization. If disrupted, halo vest for bony avulsion or c12 fusion for intrasubstance tear see dickman classification below. If the instability risk is less than 70%, the hand can be manipulated under regional block or. Jefferson fracture is the eponymous name given to a burst fracture of the atlas. Jefferson classification of c1 fractures uw emergency radiology. If the fracture affects the median nerve, only then is a reduction indicated. A typical mechanism of injury is diving head first into shallow water. When there are both anterior and posterior arch fractures this is called a burst fracture also known as a jeffersons fracture and occurs when the occipital condyles are forced into the.
The contact makes the neck violently snap back or forward, cracking the ringshaped c1. Oct 19, 2017 a jefferson fracture is often caused by trauma to the back of the head. None had recognizable neurological signs that resulted from the injury when seen in the hospital. A hangmans fracture is a break in one of the vertebrae of the neck. Surgical management of a combined fracture of the odontoid. Fractures and related injuries matthew cham medical student university of rochester. Trauma xray axial skeleton gallery 1 cervical spine c1. Appearance on relevant modalities the classic jefferson fracture fig. This fracture of all aspects of the c1 ring is associated with possible disruption of. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as. The lateral mass on vertebra c1, who is taller, is directed laterally. None of the patients underwent fusion of the cervical spine.
The assessment and initial management of acute fractures is discussed separately. The second image is a coronal reconstruction from a ct, which confirms the findings from the odontoid view. What is a jefferson fracture of the cervical spine. Type ii injuries, also known as jefferson fractures, are burst fractures with bilateral fractures of the anterior and posterior arch of c1.
Cerebellar infarction resulting from vertebral artery occlusion associated with a jefferson fracture. It was originally described as a fourpart fracture with double fractures through the anterior and posterior arches, but threepart and twopart fractures have also been described. Ct confirms a jefferson fracture of c1 with single fractures through the anterior and posterior arches. Alsobrook, md, south bend sports medicine program, south bend, indiana. While it can be quite serious, this break can usually be treated successfully. Jun 29, 2016 once identified, atlas fractures can be classified by the fracture pattern table table1. In this image the corners of the c1 lateral masses appear more laterally placed than those of c2.
Diagnosis and management of metatarsal fractures american. Background jefferson fractures are classically described as burst fractures of c1. Although usually not immediately lifethreatening, serious fractures can be fatal if not properly treated. The vertebra c1 is a bony ring, with two wedge shaped lateral masses, connected by relatively thin anterior and posterior arches and a transverse ligament. Proceedings of the international consensus meeting on. The traditional treatment is a halo vest or cast until the jefferson fracture is healed. The remainder of the patients had stable jefferson fractures and were managed with minerva jackets or rigid collar stabilization. This subcourse discusses the procedures for immobilizing fractures. There were 15 cases in which the fracture line went through the base of the odontoid process only type 2, 1 case with a type 2 odontoid fracture associated with a jefferson fracture, 4 in which the fracture line involved the body of c2 type 3, and 2 cases with a type 3 odontoid fracture associated with a jefferson fracture. B jefferson fracture caused by a vertical axial compression mechanism is unstable. Simple fractures of the diaphysis or metaphysis are spiral, oblique, or transverse. The isolated fracture of the atlas, or jefferson fracture, has been an injury of historic interest and remains clinically germane. This indicates a burst injury of c1 atlas also known as a.
Jefferson burst fracture with bilateral fractures of anterior and posterior arch resulting from axial load. Jefferson fracture both bone forearm fracture tibfib fracture jones fracture bennetts fracture straddle fracture. Traditional surgical treatment of these unstable fractures is either occipitocervical or posterior c1c2 fusion, resulting in a significant loss of range of cervical neck movement. Jefferson classification of c1 fractures uw emergency. In its originally described form, which was first reported by geofrey jefferson in 1920, the jefferson fracture is a complex burst fracture of the ring of the c1 vertebra, involving fractures of the anterior and posterior arches of the atlas on both the right. Aug 20, 2019 alternative consideration may be given to a transoral approach or an anterior retropharyngeal approach for the combination of a jefferson fracture and a fracture of the odontoid. Management with early mobilization using the halo device.
Type 2, 1 case with a type 2 odontoid fracture associated with a jefferson fracture, 4 in which the fracture line involved the body of c2 type 3, and 2 cases with a type 3 odontoid fracture associated with a jefferson fracture. Nonoperative management most fractures in most fractures in thoracolumbarthoracolumbarlumbar region lumbar region consist of compression, burst fractures, and consist of compression, burst fractures, and. The remainder of the patients had stable jefferson fractures and were managed with. Basic principles of fracture management slideshare. Thoracolumbar and lumbar burst fractures sussan salas, md thomas jefferson university hospital thomas jefferson university hospital department of neurological surgerydepartment of neurological surgery. A jefferson fracture, or atlas fracture, is a bone break within the anterior and posterior arches of the c1 vertebra, named after the british neurosurgeon sir geoffrey jefferson who wrote reports about the fracture in 1920. Nonoperative management of these fractures is effective in most cases of lowgrade fracture with surgical management being reserved for highergrade variants and those that show nonunion or a progression after nonoperative management.
Therefore vertical forces compressing the lateral masses between the occipital condyles and the axis drive. Xrays showed a type ii forward sloping odontoid fracture with anterior displacement associated with a fracture of the posterior c1 arch. High prevalence of concomitant fractures of c2 the unstable jefferson fracture is a c1 burst fracture with concomitant injury of the transverse atlantal ligament fourpart atlas fracture, with two in the posterior arch and two in the anterior arch. Principles in fractures management linkedin slideshare. Fracture management an overview sciencedirect topics. This fracture of all aspects of the c1 ring is associated with possible disruption of the transverse ligament. The general principles of fracture management is to reduce the fracture open or closed in a manner that will restore normal anatomy and maintain the reduced position through an immobilizationfixation technique that is sufficient to withstand the potential for loss of reduction through deforming or external forces. The fracture may result from an axial load on the back of the head or hyperextension of the neck e. Jefferson fractures c1 and atlas fractures information. Principles and practice, 3rd, wb saunders, philadelphia 2010. Traumatic fracture can be transverse, oblique, spiral, displaced. Six cases of jefferson fracture of the atlas are summarized. Traumatic spondylolisthesis of the axis, is a common cervical spine fracture.
He was immediately hit anteriorly and had a twisting and hyperextension injury to his knee with severe pain. Direct fixation of c1 jefferson fracture using c1 lateral. Intraarticular fracture of the proximal end of the first metacarpal, with. In the above odontoid view, the lateral displacement of c1 indicates a jefferson fracture. A lateral displacement of 2 mm or unilateral displacement may be indicative of a c1 fracture. Intraarticular fracture of the proximal end of the first metacarpal, with dorsal and lateral dislocation of the distal segment. Trauma xray axial skeleton gallery 1 cervical spine. Note the small amount of healing new bone formation consistent with this ct being performed several weeks after the initial injury. This makes jefferson one of the largest regional referral centers for acute, subacute and chronic shoulder and elbow fractures and related conditions in the area.
A jefferson fracture is a bone fracture of the vertebra c1. When there are both anterior and posterior arch fractures this is called a burst fracture also known as a jefferson s fracture and occurs when the occipital condyles are forced into the lateral masses of c1. The classic jefferson fracture results from an axial load with forces transmitted through the occipital condyles to the lateral masses, causing a burst fracture of c1. Type of fracture fracture personality fracture displacement. Jefferson fracture definition of jefferson fracture by. Sep 15, 2007 diagnosis and management of metatarsal fractures robert l. Sep 09, 2015 a unified nomenclature system for fracture subtypes will aid in developing evidencebased management strategies. Evaluation and treatment of atlas burst fractures jefferson. Fractures and dislocations university of cincinnati. We also studied fracture patterns and their treatment outcomes. Stability determined by integrity of transverse ligament. They should also inform both physicians and patients of the prognosis for the injury. Imaging of the cervical spine fractures jefferson fracture.
In displaced distal radius fracture, in those with low demands, the hand can be cast until the person feels comfortable. Management of typical and atypical hangmans fractures. Treating fractures in the field introduction one of the more common injuries on a battlefield or in everyday life is a fracture. Spinal stabilization and management zprotect spine at all times during the management of patients with multiple injuries. Unilateral c1 lateral mass sagittal split fracture. Lumbar burst fractures sussan salas, md thomas jefferson university hospital thomas jefferson university hospital. Four patients were noted to have unstable jefferson fractures. Fractures and dislocations keith kenter, md assistant professor.
Vertebral artery injury associated with a jefferson. With conservative treatment, pain subsided and the fracture stabilized in a short period in all six patients. A c1 atlas vertebral fracture that usually occurs after an axial load injury during a diving accident. Vertebral artery injury associated with a jefferson fracture. The first image is the odontoid view, which illustrates the lateral displacement of c1. To address this, the international consensus meeting on periprosthetic joint infection was organized.
Jefferson fracture 2% of all cervical spine fractures. Management of fracture nonunion and malunion is an area of special interest to our shoulder and elbow group. Hatch, md, mph, university of florida, gainesville, florida john a. Bone name simply start by naming the bone commonly named examples. Fracture management for primary care, 3rd, wb saunders, philadelphia 2011. Bone healing and fracture description and general principles of acute fracture management. Delegates from disciplines including orthopaedic surgery, infectious disease, and many others participated.1080 633 1576 655 108 1026 1146 1221 964 454 381 147 141 216 292 1387 1573 1387 1319 679 536 241 1453 555 2 343 951 22 1202 385 1295 371 893 487 35 1314 453