Jefferson fracture

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Jefferson fracture
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Image of the first cervical vertebra, which is broken during a Jefferson fracture
Specialty Orthopedics

A Jefferson fracture is a bone fracture of the anterior and posterior arches of the C1 vertebra, [1] though it may also appear as a three- or two-part fracture. The fracture may result from an axial load on the back of the head or hyperextension of the neck (e.g. caused by diving), causing a posterior break, and may be accompanied by a break in other parts of the cervical spine. [1]

Contents

It is named after the British neurologist and neurosurgeon Sir Geoffrey Jefferson, who reported four cases of the fracture in 1920 in addition to reviewing cases that had been reported previously. [2]

Signs and symptoms

Individuals with Jefferson fractures usually experience pain in the upper neck but no neurological signs. The fracture may also cause damage to the arteries in the neck, resulting in lateral medullary syndrome, Horner's syndrome, ataxia, and the inability to sense pain or temperature. [1]

In rare cases, congenital abnormality may cause the same symptoms as a Jefferson fracture. [3] [4]

Cause

Axial CT scan showing a Jefferson fracture. Jeffersonfraktur - 84jm- CT axial - 001.jpg
Axial CT scan showing a Jefferson fracture.

Jefferson fracture is often caused by an impact or load on the back of the head, and are frequently associated with diving into shallow water, impact against the roof of a vehicle and falls, [5] and in children may occur due to falls from playground equipment. [6] Less frequently, strong rotation of the head may also result in Jefferson fractures. [5]

Jefferson fractures are extremely rare in children, but recovery is usually complete without surgery. [6]

Diagnosis

Treatment

The use of surgery to treat a Jefferson fracture is somewhat controversial. [7] Non-surgical treatment varies depending on if the fracture is stable or unstable, defined by an intact or broken transverse ligament and degree of fracture of the anterior arch. [1] [8] An intact ligament requires the use of a soft or hard collar, while a ruptured ligament may require traction, a halo or surgery. The use of rigid halos can lead to intracranial infections and are often uncomfortable for individuals wearing them, and may be replaced with a more flexible alternative depending on the stability of the injured bones, but treatment of a stable injury with a halo collar can result in a full recovery. [9] Surgical treatment of a Jefferson fracture involves fusion or fixation of the first three cervical vertebrae; [1] [7] fusion may occur immediately, or later during treatment in cases where non-surgical interventions are unsuccessful. [7] A primary factor in deciding between surgical and non-surgical intervention is the degree of stability [7] [9] as well as the presence of damage to other cervical vertebrae. [9]

Though a serious injury, the long-term consequences of a Jefferson's fracture are uncertain and may not impact longevity or abilities, even if untreated. [10] Conservative treatment with an immobilization device can produce excellent long-term recovery. [11] [12]

Related Research Articles

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In anatomy, the atlas (C1) is the most superior (first) cervical vertebra of the spine and is located in the neck.

<span class="mw-page-title-main">Whiplash (medicine)</span> Injuries to the neck

Whiplash associated disorders (WAD), is a range of injuries to the neck caused by or related to a sudden distortion of the neck associated with extension, although the exact injury mechanisms remain unknown. The term "whiplash" is a colloquialism. "Cervical acceleration–deceleration" (CAD) describes the mechanism of the injury, while WAD describes the subsequent injuries and symptoms.

<span class="mw-page-title-main">Axis (anatomy)</span> Second cervical vertebra of the spine

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<span class="mw-page-title-main">Cervical collar</span> Medical device used to support a neck

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<span class="mw-page-title-main">Cervical vertebrae</span> Vertebrae of the neck

In tetrapods, cervical vertebrae are the vertebrae of the neck, immediately below the skull. Truncal vertebrae lie caudal of cervical vertebrae. In sauropsid species, the cervical vertebrae bear cervical ribs. In lizards and saurischian dinosaurs, the cervical ribs are large; in birds, they are small and completely fused to the vertebrae. The vertebral transverse processes of mammals are homologous to the cervical ribs of other amniotes. Most mammals have seven cervical vertebrae, with the only three known exceptions being the manatee with six, the two-toed sloth with five or six, and the three-toed sloth with nine.

<span class="mw-page-title-main">Cervical fracture</span> Medical condition

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<span class="mw-page-title-main">Degenerative disc disease</span> Medical condition

Degenerative disc disease (DDD) is a medical condition typically brought on by the aging process in which there are anatomic changes and possibly a loss of function of one or more intervertebral discs of the spine. DDD can take place with or without symptoms, but is typically identified once symptoms arise. The root cause is thought to be loss of soluble proteins within the fluid contained in the disc with resultant reduction of the oncotic pressure, which in turn causes loss of fluid volume. Normal downward forces cause the affected disc to lose height, and the distance between vertebrae is reduced. The anulus fibrosus, the tough outer layers of a disc, also weakens. This loss of height causes laxity of the longitudinal ligaments, which may allow anterior, posterior, or lateral shifting of the vertebral bodies, causing facet joint malalignment and arthritis; scoliosis; cervical hyperlordosis; thoracic hyperkyphosis; lumbar hyperlordosis; narrowing of the space available for the spinal tract within the vertebra ; or narrowing of the space through which a spinal nerve exits with resultant inflammation and impingement of a spinal nerve, causing a radiculopathy.

<span class="mw-page-title-main">Clavicle fracture</span> Medical condition

A clavicle fracture, also known as a broken collarbone, is a bone fracture of the clavicle. Symptoms typically include pain at the site of the break and a decreased ability to move the affected arm. Complications can include a collection of air in the pleural space surrounding the lung (pneumothorax), injury to the nerves or blood vessels in the area, and an unpleasant appearance.

<span class="mw-page-title-main">Hip fracture</span> Broken bone in hip joint region

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<span class="mw-page-title-main">Lisfranc injury</span> Type of fracture/dislocation injury of the foot

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<span class="mw-page-title-main">Transverse ligament of atlas</span>

In anatomy, the transverse ligament of the atlas is a broad, tough ligament which arches across the ring of the atlas posterior to the dens to keep the dens in contact with the atlas. It forms the transverse component of the cruciform ligament of atlas.

<span class="mw-page-title-main">Hangman's fracture</span> Medical condition

Hangman's fracture is the colloquial name given to a fracture of both pedicles, or partes interarticulares, of the axis vertebra (C2).

<span class="mw-page-title-main">Occipital condyles</span> Undersurface protuberances of the occipital bone in vertebrates

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<span class="mw-page-title-main">Pelvic fracture</span> Broken bone in nonacetabular portions of pelvis

A pelvic fracture is a break of the bony structure of the pelvis. This includes any break of the sacrum, hip bones, or tailbone. Symptoms include pain, particularly with movement. Complications may include internal bleeding, injury to the bladder, or vaginal trauma.

Atlanto-occipital dislocation, orthopedic decapitation, or internal decapitation describes ligamentous separation of the spinal column from the skull base. It is possible for a human to survive such an injury; however, 70% of cases result in immediate death. It should not be confused with atlanto-axial dislocation, which describes ligamentous separation between the first and second cervical vertebra.

<span class="mw-page-title-main">Mandibular fracture</span> Medical condition

Mandibular fracture, also known as fracture of the jaw, is a break through the mandibular bone. In about 60% of cases the break occurs in two places. It may result in a decreased ability to fully open the mouth. Often the teeth will not feel properly aligned or there may be bleeding of the gums. Mandibular fractures occur most commonly among males in their 30s.

<span class="mw-page-title-main">Spinal fracture</span> Medical condition

A spinal fracture, also called a vertebral fracture or a broken back, is a fracture affecting the vertebrae of the spinal column. Most types of spinal fracture confer a significant risk of spinal cord injury. After the immediate trauma, there is a risk of spinal cord injury if the fracture is unstable, that is, likely to change alignment without internal or external fixation.

<span class="mw-page-title-main">Spinal stenosis</span> Disease of the bony spine that results in narrowing of the spinal canal

Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with leaning forward. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.

The hyoid bone fracture is a very rare fracture of the hyoid bone, accounting for 0.002% of all fractures in humans. It is commonly associated with strangulation and rarely occurs in isolation. The fracture may be associated with gunshot injury, car accidents or induced vomiting. In 50% of strangulations and 27% of hangings, hyoid fractures occur.

References

  1. 1 2 3 4 5 Wheeless, Clifford. "Atlas Frx / Jefferson Fracture". Duke University Division of Orthopaedic Surgery. Retrieved 2007-11-29.
  2. ↑ Jefferson G (1920). "Fracture of the atlas vertebra: report of four cases, and a review of those previously recorded". Br J Surg. 7 (27): 407–22. doi:10.1002/bjs.1800072713. S2CID   71921223.
  3. ↑ de Zoete A, Langeveld UA (2007). "A congenital anomaly of the atlas as a diagnostic dilemma: a case report". J Manipulative Physiol Ther. 30 (1): 62–4. doi:10.1016/j.jmpt.2006.11.011. PMID   17224357.
  4. ↑ Gehweiler JA, Daffner RH, Roberts L (1983). "Malformations of the atlas vertebra simulating the Jefferson fracture". AJR Am J Roentgenol. 140 (6): 1083–6. doi: 10.2214/ajr.140.6.1083 . PMID   6602470.
  5. 1 2 Foster, Mark (2006-12-01). "C1 Fractures". WebMD . Retrieved 2007-11-29.
  6. 1 2 Korinth MC, Kapser A, Weinzierl MR (2007). "Jefferson fracture in a child--illustrative case report". Pediatr Neurosurg. 43 (6): 526–30. doi:10.1159/000108801. PMID   17992046. S2CID   42460934.
  7. 1 2 3 4 Hein C, Richter HP, Rath SA (2002). "Atlantoaxial screw fixation for the treatment of isolated and combined unstable jefferson fractures - experiences with 8 patients". Acta Neurochir (Wien). 144 (11): 1187–92. doi:10.1007/s00701-002-0998-2. PMID   12434175. S2CID   21585373.
  8. ↑ Lee C, Woodring JH (1991). "Unstable Jefferson variant atlas fractures: an unrecognized cervical injury". AJNR Am J Neuroradiol. 12 (6): 1105–10. PMC   8331492 . PMID   1763734.
  9. 1 2 3 Lee TT, Green BA, Petrin DR (1998). "Treatment of stable burst fracture of the atlas (Jefferson fracture) with rigid cervical collar". Spine. 23 (18): 1963–7. doi:10.1097/00007632-199809150-00008. PMID   9779528. S2CID   13030871.
  10. ↑ Mindell ER (2005). "James Platt White, MD (1811-1881): his interesting and remarkable accident". Clin. Orthop. Relat. Res. (430): 227–31. doi:10.1097/01.blo.0000150454.54856.08. PMID   15662328.
  11. ↑ Kesterson L, Benzel E, Orrison W, Coleman J (1991). "Evaluation and treatment of atlas burst fractures (Jefferson fractures)". J. Neurosurg. 75 (2): 213–20. doi:10.3171/jns.1991.75.2.0213. PMID   2072157.
  12. ↑ Claux E, Everaert P (1989). "[Result 5 years after orthopedic treatment of a Jefferson fracture]". Acta Orthop Belg (in French). 55 (2): 233–7. PMID   2801087.
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