Become a Pro Member for full access to this course and more.

View Plans   Log In
Expand ("E")   Collapse

Age: 59

Sex: Male

Indication: Trauma

Save ("V")

Case #4


Findings

  • Comminuted four part C1 fracture extending into the transverse foramen on the left
  • Anterior dislocation of the left C1 lateral mass from the occipital condyle
  • Widening of the atlantodental interval on the right
  • Slight asymmetric widening of the left C1-C2 articulation
  • Inferiorly displaced and distracted C6 spinous process fracture
  • Possible mildly displaced right C7 transverse process fracture


Diagnosis

  • Jefferson fracture

Sample Report

Comminuted four part C1 fracture (Jefferson fracture) extending into the transverse foramen on the left. Recommend neck CTA to assess for vascular injury.

Anterior dislocation of the left C1 lateral mass from the occipital condyle, widening of the atlantodental interval on the right, and slight asymmetric widening of the left C1-C2 articulation suggest ligamentous injury. Consider MRI for further evaluation.

Inferiorly displaced and distracted C6 spinous process fracture.

Possible mildly displaced right C7 transverse process fracture.


Discussion

  • Jefferson fractures are C1 burst fractures associated with axial loading (e.g. diving into the shallow end of a swimming pool). Whether or not they are stable depends on the degree of fracture fragment displacement as well as associated ligament injury
  • Given the mechanism, if you see an injury like this make sure you look at the head CT closely for signs of intracranial trauma


Images

Red arrows: four-part C1 burst fracture. This fracture was unstable and required internal fixation. Fractures of the atlas.

Video Reviews

Cervical Spine Trauma

📣 Feedback?

⌨️  Keyboard Shortcuts ("K")

⌨️ Keyboard Shortcuts

View shortcuts

Zoom/Pan

  Full screen

  Window/Level

  Expand/collapse

  Scroll

  Save the case

  Close case/tab

Previous Slice (Scroll)

Next Slice (Scroll)

 Toggle presets

 Previous series (if multiple)

 Next series (if multiple)

  Previous case (⌘ ◄ on a mac)

  Next case (⌘ ► on a mac)