Jefferson Burst Fracture

1. Spine Case # 5

2. History and Physical 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. Image : http://imageinterpretation.co.uk/cervical.html

4. Diagnosis: Jeffersonian Burst fracture Description compression fracture of C1 with splitting of the lateral masses and tearing of the transverse ligament. Mechanism Axial blow to the head . Radiographic features 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 : unstable © 2000 by the Rector & Visitors of the University of Virginia http://www.med-ed.virginia.edu/courses/rad/cspine

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 ED Management 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 Clinical Pearls http://www.wheelessonline.com/ortho/atlas_frx_jefferson_fracture