When there are both anterior and posterior arch fractures this is called a burst fracture also known as a jefferson s fracture and occurs when the occipital condyles are. Management of isolated fractures of the atlas in adults. With conservative treatment, pain subsided and the fracture stabilized in a short period in all six patients. A concomitant injury of the cervical spine was found in 59. Simple fractures of the diaphysis or metaphysis are spiral, oblique, or transverse.
Principles of initial management prevent further damage. Contributors col patrick osborn, usaf, mc maj vincente nelson, mc, usa lt col r. By describing and defining the unstable jefferson variant fracture as a distinct clinical and radiologic entity, we hoped to emphasize its significance as well contrast it against the classic jefferson fracture, which has not been reported. A case report found that the treatment of unstable burst fractures of the atlas jefferson. This series of articles has been presented in 3 parts, with. Guidelines on the management of atlanto juniper publishers. Use of videoassisted intubation devices in the management of patients with trauma.
Atlas c1 fractures represent about 25% of all craniocervical injuries and 2% to % of all cervical spine injuries. Original article management of combination fractures of the atlas. A practitioners guide to fracture management part 3. Based on jefferson s classification, the most common fracture types seen in various clinical series are type i. Jefferson fracture compression of base of skull against c1. The contact makes the neck violently snap back or forward, cracking the ringshaped c1. Jefferson and hangman fractures formazionesostenibile. Solitary c1 posterior fixation for unstable isolated atlas.
A c1 atlas vertebral fracture that usually occurs after an axial load injury during a diving accident. Although nonoperative management may be appropriate with slight c1 displacement in the presence of an intact transverse ligament, unstable jefferson fractures typically warrant surgery. A jefferson fracture is a bone fracture of the anterior and posterior arches of the c1 vertebra, though it may also appear as a three or twopart fracture. Reduce if displaced may be by open reduction, closed manipulation, or traction 3. Spinal stabilization and management zprotect spine at all times during the management of patients with multiple injuries. A case of colletsicard syndrome associated with traumatic atlas. Four patients were noted to have unstable jefferson fractures.
Jefferson fracture, atlas, cervical, burst fracture, rigid cer vical collar, transverse ligament rupture. Thirteen of 23 patients 56% followed up a minimum of 1 year posttrauma had significant symptoms of scalp dysesthesia, neck. Hold hold is the generic term used to describe immobilising a fracture. Fractures of the atlas vertebra are generally considered to be innocuous injuries. A jefferson fracture is a bone fracture of the vertebra c1. Jefferson fractures, or burst fractures of the c1 vertebra, can be managed surgically or conservatively, depending on their stability. Surgical management of a combined fracture of the odontoid. Type i fractures that do not involve injury to the ligament structures supporting the atlantooccipital. Bilateral posterior with uni or bilateral anterior arch.
Surgical options include c1c2 fixation, with occipitocervical fusion reserved for those with the most complex findings. These fractures are frequently associated with other cervical fractures or ligamentous traumatic injuries. Jefferson fracture the color atlas of physical therapy. Unilateral or bilat fxs of both ant and post arches of c1 2. Cranial skeletal traction was employed to provide ligamentotaxis and help reduce the fracture fragments, and a standard open posterior midline approach was used to carefully dissect and expose the first cervical vertebra to access the lateral masses for placement.
When there are both anterior and posterior arch fractures this is called a burst fracture also known as a jefferson s fracture and occurs when the occipital condyles are forced into the lateral masses of c1. Acute fractures of the atlas c1 represent 1% to 2% of spinal column fractures and account for 2% to % of all acute cervical spine fractures. The classic jefferson fracture results from an axial load with forces transmitted through the occipital condyles to the lateral masses, causing a burst fracture of c1. Proceedings of the international consensus meeting on.
Nonoperative management most fractures in most fractures in thoracolumbarthoracolumbarlumbar region lumbar region consist of compression, burst fractures, and consist of compression, burst fractures, and isolated dorsal column fractures isolated dorsal column fractures stable stable fxsfxs. Initially, it is important to consider whether traction is needed this is most commonly employed for subtrochanteric neck of femur fractures, femoral shaft fractures, displaced acetabular fractures, and some pelvic fractures, whereby the muscular pull across the fracture site is strong and the fracture is. It was originally described as a fourpart fracture with double fractures through the anterior and posterior arches, but threepart and twopart fractures have also been described. The combined injury of the anterior and posterior arch of the atlas, the classic jefferson fracture, corresponds to a gehweiler 3 fracture corresponding to jefferson 3. Stability depends on integrity of the transverse ligament. Most fractures were managed nonsurgically regardless of stability. Jefferson classification of c1 fractures uw emergency radiology.
The physician and patient decided to treat the fracture with immobilization with halo traction and halo vest. Part 1 describing fracture biomechanics, classification, and diagnosis. The fracture may result from an axial load on the back of the head or hyperextension of the neck e. None had recognizable neurological signs that resulted from the injury when seen in the hospital. None of the patients underwent fusion of the cervical spine. Coding for spinal procedures ahima 2009 audio seminar series 8 notescommentsquestions pathological conditions 324. Unstable jefferson fractures with concurrent unstable fracture of other cervical. Atlantodens interval, mechanism of injury, and fracture type affect jefferson fracture management decisions and outcomes, including instability at presentation and fusion at followup.
Burst fractures of the atlas are caused by massive axial loads. Jefferson classification of c1 fractures uw emergency. Based on jefferson s classification, the most common fracture types seen in various clinical series are type i followed by type iii. Approximately 3 weeks after his initial injury, the patient underwent a solitary open reduction and fixation of his atlas vertebra. Atlas fractures, jefferson fracture, rule of spence, transverse atlantal ligament. The various treatment options, such as cervical collar, halo immobilization, occipitocervical fusion. This chapter explores the diagnosis and management of c1 fractures, as well as outcomes after treatment.
Burst fractures of the atlas jefferson fractures are injuries of the. Fracture risk increases with age, with four in 10 white. Although the incidence of stress fractures of the elbow is increasing, there is a lack of data in the literature focused on throwers. Direct fixation of c1 jefferson fracture using c1 lateral. Diagnosis and management of vertebral compression fractures. Appearance on relevant modalities the classic jefferson fracture fig. Evaluation and treatment of atlas burst fractures jefferson. Direct fixation of c1 jefferson fracture using c1 lateral mass screws. Retain to maintain position while healing occurs by internal fixation, external fixation, or conservative methods 4. Ct required for defining full extent of fracture and detecting fragments in spinal cordcanal 4.
By describing and defining the unstable jefferson variant fracture as a distinct clinical and radiologic entity, we hoped to emphasize its significance as well contrast it against the classic jefferson fracture, which has not been reported to be associated with permanent neurologic injury 14. The remainder of the patients had stable jefferson fractures and were managed with minerva jackets or rigid collar stabilization. Feb 10, 2021 the jefferson fracture is a bursttype fracture to the atlas first described in 1919, characterized by anterior and posterior fractures of the weak c1 ring caused by a sudden axial load to the. Stress fractures of the elbow in the throwing athlete. Jefferson fracture is the eponymous name given to a burst fracture of the atlas.
In a retrospective study, consecutive patients diagnosed with a fracture of the atlas between 012008 and 072018 were analyzed. Stress fractures of the elbow are rare in throwing athletes and present a challenge from both a management and rehabilitation perspective. Nov 09, 20 fractures of the atlas fractures of the atlas account for approximately 12% of all fractures. Although there is a general agreement on the treatment of stable jefferson fractures, the management of unstable jefferson fractures remains controversial. Rehabilitate r esuscitate advanced trauma life support. Jefferson fracture 2% of all cervical spine fractures. Methods we identified all patients who were treated for a c1 fracture at our institution between 1999 and 2016 for retrospective analysis. The management of unstable jefferson fractures is controversial. Patient is a 36yearold construction worker who fell off a ladder and had a burst fracture of the atlas. Based on the findings, the simplest orthosis consistent with appropriate treatment of any of the often associated other spine fractures is recommended. Sep 18, 2018 a jefferson fracture is often caused by trauma to the back of the head. Jul 01, 2016 vertebral compression fractures vcfs are the most common complication of osteoporosis, affecting more than 700,000 americans annually. Halo immobilization is a viable option with acceptable radiographic results and low rates of nonunion or instability. Jefferson fractures are typically treated conservatively hard.
The jefferson fracture is a bursttype fracture to the atlas first described in 1919, characterized by anterior and posterior fractures of the weak c1 ring caused by a sudden axial load to the. This case report discusses the fixation of a jefferson fracture using c1 lateral mass screws to. High prevalence of concomitant fractures of c2 the unstable jefferson fracture is a c1 burst fracture with concomitant injury of the transverse atlantal ligament fourpart atlas fracture, with two in the posterior arch and two in the anterior arch. Management of isolated fractures of the atlas in adults oxford. In treating a fracture, the objectives of the treatment are as follows. Management fracture management stages include 4 rs. Due to the lack of widely accepted algorithms guiding the management of isolated cervical facet fractures. Initial assessment open fractures usually result from high energy trauma and occur in of cases of multiply injured trauma. What is a jefferson fracture of the cervical spine. Epidemiology and management of atlas fractures springerlink. Jan 30, 2020 the purpose of this study was to gain new insights into the epidemiologic characteristics of patients with atlas fractures and to retrospectively evaluate complication rates after surgical and nonsurgical treatment. Success rates and odds ratios were derived from the quantitative data obtained. Principles of initial management prevent further damage assume a spine injury until proven otherwise.
549 977 777 1796 549 1778 1747 1347 779 628 1802 911 212 1575 932 1694 540 550 1512 1114 861 1815