Jefferson fracture


Refers to a bone fracture of the anterior and posterior arches of the C1 vertebra.

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 as caused by diving, causing a posterior break, and may be accompanied by a break in other parts of the cervical spine.

Patients with such fractures usually experience pain in the upper neck but no neurological signs.

A Jefferson 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.

Frequently associated with diving into shallow water, impact against the roof of a vehicle and falls, and in children may occur due to falls from playground equipment.

Strong rotation of the head may also result in such fractures.

An extremely rare fracture in children, and recovery is usually complete without surgery.

Non-surgical treatment varies depends on if the fracture is stable or unstable.

Stability of the fracture is defined by an intact or broken transverse ligament and degree of fracture of the anterior arch.

Jefferson fractures are typically seen after the patient sustains an axial load to the skull, and can be associated with tears of the transverse ligament that render the C1 and C2 vertebrae unstable.

Ruptures of the ligament can compromise the atlantodental relationship between the first two vertebrae, because displacement of the dens and, possibly compressing the thecal sac and its contents.

Atlantoccipital disassociation results from high energy trauma.

The ligamentous complex is the principal source of stability in the atlantooccipital joint.

With an intact ligament the use of a soft or hard collar is required.

With a ruptured ligament traction, a halo or surgery may be required.

Surgical treatment involves fusion or fixation of the first three cervical vertebrae.

In deciding between surgical and non-surgical intervention the degree of stability, and the presence of damage to other cervical vertebrae are considered.

The use of surgery to treat a Jefferson fracture is somewhat controversial, as conservative treatment with an immobilization device can produce excellent long-term recovery.

The long-term consequences of such a fracture are uncertain and may not impact longevity or abilities, even if untreated.

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