Spine Injuries

Fig. 22.3. Illustration of the common types of fractures of the atlas, or C1. A classification involving four types of fracture patterns has been described, involving (A) the posterior arch, (B) the lateral masses, (C) Jefferson fractures and (D) the horizontal transverse process fracture of the anterior arch. Extension and axial loading are associated with posterior arch fractures. Extension associated with lateral bending results in a lateral mass fracture of C1. A burst fracture of C1, first described by Geoffrey Jefferson in 1920, is the result of an axial compression, generally with a direct blow on the head, as seen in diving accidents or when an object falls on the head. In this type of injury, there is bilateral spreading of the lateral masses, with both anterior and posterior arches failing. The transverse fracture of the atlas occurs as a result of hyperextension, which results in an avulsion fracture.

Fig. 22.3. Illustration of the common types of fractures of the atlas, or C1. A classification involving four types of fracture patterns has been described, involving (A) the posterior arch, (B) the lateral masses, (C) Jefferson fractures and (D) the horizontal transverse process fracture of the anterior arch. Extension and axial loading are associated with posterior arch fractures. Extension associated with lateral bending results in a lateral mass fracture of C1. A burst fracture of C1, first described by Geoffrey Jefferson in 1920, is the result of an axial compression, generally with a direct blow on the head, as seen in diving accidents or when an object falls on the head. In this type of injury, there is bilateral spreading of the lateral masses, with both anterior and posterior arches failing. The transverse fracture of the atlas occurs as a result of hyperextension, which results in an avulsion fracture.

A burst fracture of C1, first described by Geoffrey Jefferson in 1920, is the result of an axial compression, generally with a direct blow to the head as seen in diving accidents or when an object falls on the head. An additional fracture of C2, such as a dens fracture, occurs in 41% of Jefferson fractures. In this type of injury, there is bilateral spreading of the lateral masses, with both anterior and posterior arches failing. Clinically, it is rare for patients to have an associated neurological deficit, although this is considered an unstable injury. When lateral displacement of the lateral masses totals a distance of greater than 7 mm, it is presumed that transverse ligamentous disruption has occurred, as described by Spence and associates [17]. CT and MRI can confirm whether there has been an avulsion of the bony attachment of the ligament and integrity of the ligament, respectively. Halo vest placement is advocated for this type of injury. In the cases of severe lateral mass displacement, traction has been recommended to

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