2.  21 yo male presents to ED
w/ moderate midline
cervical pain after falling
headfirst into the shallow
end of a pool. Pt was
wrestling w/ friends when
he was accidentally shoved
into pool. Denies LOC. Pt
able to ambulate on scene
after injury. Denies any
other complaints.
 T 98.2 P 65 BP 122/78




O2 98% RA RR 16
Gen: WDWN, NAD
HEENT: NCAT, PERRL,
EOMI
Back: mild midline cervical
tenderness w/out edema,
step offs, or bony
abnormality
Neuro: A&O x 3, CNII-XII
intact; 5/5 strength
throughout, no focal
sensory or motor deficits
apprecitaed

3. :http://imageinterpretation.co.uk/cervical.html

4. •
Description
•
•
Mechanism
•
•
•
•
AP open mouth
Displacement of the lateral masses
of C1 beyond the margins of the
body of vertebra C2.
A lateral displacement of >2 mm or
unilateral displacement may be
indicative of a C1 fracture.
Stability:
•
© 2000 by the Rector & Visitors of the University of Virginia
http://www.med-ed.virginia.edu/courses/rad/cspine
Axial blow to the head.
Radiographic features
•
•
compression fracture of C1 with
splitting of the lateral masses and
tearing of the transverse ligament.
unstable

5.  Cervical spine immobilization
 Spine consult
 Nondisplaced or minimally displaced fx is treated w/
orthosis
 minimally displaced fracture (and overhang is < 7 mm),
should be treated in a rigid support (cervicothoracic
brace for 3 month)
 soft-collar treatment is sufficient for isolated posterior
arch frx
 Unstable fx w/ separation of lateral masses
 Tx w/ halo or skeletal traction and/or cervical fusion
http://www.wheelessonline.com/ortho/atlas_frx_jefferson_fracture

6.  Flexion/extension views are usually required to assess
for transverse ligament disruption
 On Odontoid view, if the sum of lateral mass
displacement of axis is >7 mm, transverse ligament is
likely to be torn
http://www.wheelessonline.com/ortho/atlas_frx_jefferson_fracture