Jefferson fracture
Encyclopedia
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 two part fracture. The fracture may result from an axial load on the back of the head or hyperextension
of the neck, causing a posterior break, and may be accompanied by a break in other parts of the cervical spine.
It is named after the British
neurologist and neurosurgeon Sir Geoffrey Jefferson
, who reported four cases of the fracture in 1920 in addition to reviewing cases that had been reported previously.
, and are frequently associated with diving into shallow water, impact against the roof of a vehicle and falls, and in children may occur due to falls from playground equipment. Less frequently, strong rotation
of the head may also result in Jefferson fractures.
Jefferson fractures are extremely rare in children, but recovery is usually complete without surgery
.
in the upper neck but no neurological signs. The fracture may also cause damage to the arteries in the neck, resulting in lateral medullary syndrome
, Horner's syndrome
, ataxia
, and the inability to sense pain or temperature.
In rare cases, congenital abnormality
may cause the same symptoms as a Jefferson fracture.
to treat a Jefferson fracture is somewhat controversial. Non-surgical treatment varies depending on if the fracture is stable or unstable, defined by an intact or broken transverse ligament
and degree of fracture of the anterior arch. An intact ligament requires the use of a soft or hard collar, while a ruptured ligament may require traction
, a halo or surgery. The use of rigid halos can lead to intracranial infections and are often uncomfortable for individuals wearing them, and may be replaced with a more flexible alternative depending on the stability of the injured bones, but treatment of a stable injury with a halo collar can result in a full recovery. Surgical treatment of a Jefferson fracture involves fusion or fixation
of the first three cervical vertebrae
; fusion may occur immediately, or later during treatment in cases where non-surgical interventions are unsuccessful. A primary factor in deciding between surgical and non-surgical intervention is the degree of stability as well as the presence of damage to other cervical vertebrae.
Though a serious injury, the long-term consequences of a Jefferson's fracture are uncertain and may not impact longevity or abilities, even if untreated. Conservative treatment with an immobilization device can produce excellent long-term recovery.
Bone fracture
A bone fracture is a medical condition in which there is a break in the continuity of the bone...
of the anterior and posterior arches of the C1 vertebra, though it may also appear as a three or two part fracture. The fracture may result from an axial load on the back of the head or hyperextension
Extension (kinesiology)
In kinesiology, extension is a movement of a joint that results in increased angle between two bones or body surfaces at a joint. Extension usually results in straightening of the bones or body surfaces involved. For example, extension is produced by extending the flexed elbow. Straightening of...
of the neck, causing a posterior break, and may be accompanied by a break in other parts of the cervical spine.
It is named after the British
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
neurologist and neurosurgeon Sir Geoffrey Jefferson
Geoffrey Jefferson
Sir Geoffrey Jefferson FRS was a British neurologist and pioneering neurosurgeon. He was educated in Manchester, England, obtaining his medical degree in 1909. He became a fellow of the Royal College of Surgeons two years later. He married in 1914, and moved to Canada...
, who reported four cases of the fracture in 1920 in addition to reviewing cases that had been reported previously.
Etiology
Jefferson fractures are often caused by an impact or load on the back of the headOcciput
The occiput is the anatomical term for the posterior portion of the head, in insects the posterior part of those head capsule.-Clinical significance:Trauma to the occiput can cause a basilar skull fracture....
, and are frequently associated with diving into shallow water, impact against the roof of a vehicle and falls, and in children may occur due to falls from playground equipment. Less frequently, strong rotation
Rotation
A rotation is a circular movement of an object around a center of rotation. A three-dimensional object rotates always around an imaginary line called a rotation axis. If the axis is within the body, and passes through its center of mass the body is said to rotate upon itself, or spin. A rotation...
of the head may also result in Jefferson fractures.
Jefferson fractures are extremely rare in children, but recovery is usually complete without surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
.
Symptoms
Individuals with Jefferson fractures usually experience painPain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
in the upper neck but no neurological signs. The fracture may also cause damage to the arteries in the neck, resulting in lateral medullary syndrome
Lateral medullary syndrome
Lateral medullary syndrome is a disease in which the patient has a constellation of neurologic symptoms due to injury to the lateral part of the medulla in the brain, resulting in tissue ischemia and necrosis.-Signs and symptoms:This syndrome is characterized by sensory deficits affecting...
, Horner's syndrome
Horner's syndrome
Horner's syndrome is the combination of drooping of the eyelid and constriction of the pupil , sometimes accompanied by decreased sweating of the face on the same side; redness of the conjunctiva of the eye is often also present...
, ataxia
Ataxia
Ataxia is a neurological sign and symptom that consists of gross lack of coordination of muscle movements. Ataxia is a non-specific clinical manifestation implying dysfunction of the parts of the nervous system that coordinate movement, such as the cerebellum...
, and the inability to sense pain or temperature.
In rare cases, congenital abnormality
Congenital disorder
A congenital disorder, or congenital disease, is a condition existing at birth and often before birth, or that develops during the first month of life , regardless of causation...
may cause the same symptoms as a Jefferson fracture.
Treatment
The use of surgerySurgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
to treat a Jefferson fracture is somewhat controversial. Non-surgical treatment varies depending on if the fracture is stable or unstable, defined by an intact or broken transverse ligament
Transverse ligament of the atlas
The transverse ligament of the atlas is a thick, strong band, which arches across the ring of the atlas, and retains the odontoid process in contact with the anterior arch....
and degree of fracture of the anterior arch. An intact ligament requires the use of a soft or hard collar, while a ruptured ligament may require traction
Traction (orthopedics)
In orthopedic medicine, traction refers to the set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system.There are two types of traction: skin traction and skeletal traction....
, a halo or surgery. The use of rigid halos can lead to intracranial infections and are often uncomfortable for individuals wearing them, and may be replaced with a more flexible alternative depending on the stability of the injured bones, but treatment of a stable injury with a halo collar can result in a full recovery. Surgical treatment of a Jefferson fracture involves fusion or fixation
Vertebral fixation
Vertebral fixation is a neurosurgical procedure in which two or more vertebrae are anchored to each other through a synthetic "vertebral fixation device", with the aim of reducing vertebral mobility and thus avoiding possible damage to the spinal cord and/or spinal roots.-Indications:A vertebral...
of the first three cervical vertebrae
Cervical vertebrae
In vertebrates, cervical vertebrae are those vertebrae immediately inferior to the skull.Thoracic vertebrae in all mammalian species are defined as those vertebrae that also carry a pair of ribs, and lie caudal to the cervical vertebrae. Further caudally follow the lumbar vertebrae, which also...
; fusion may occur immediately, or later during treatment in cases where non-surgical interventions are unsuccessful. A primary factor in deciding between surgical and non-surgical intervention is the degree of stability as well as the presence of damage to other cervical vertebrae.
Though a serious injury, the long-term consequences of a Jefferson's fracture are uncertain and may not impact longevity or abilities, even if untreated. Conservative treatment with an immobilization device can produce excellent long-term recovery.