A 21-year-old male presents to the emergency department with midline cervical pain after falling headfirst into a shallow pool while wrestling with friends. On examination, he has mild midline cervical tenderness without neurological deficits. Radiographs reveal a compression fracture of C1 with splitting of the lateral masses, indicative of an unstable Jefferson fracture from an axial blow to the head. The patient requires cervical spine immobilization, orthopedic consultation, and treatment with a halo or skeletal traction and possible cervical fusion due to the instability of the fracture.

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