Jefferson fracture is the eponymous name given to a burst fracture of C1. It was originally described as a four-part fracture with double fractures through the anterior and posterior arches, but three-part and two-part fractures have also been described.
A typical mechanism of injury is diving head first into shallow water. Axial loading along the axis of the cervical spine results in the occipital condyles being driven into the lateral masses of C1. The Jefferson fracture is not normally associated with neurological deficit although spinal cord injury may occur if there is a retropulsed fragment.
- 50% are associated with other C-spine injuries
- 33% are associated with a C2 fracture
- 25-50% of young children have concurrent head injury
- vertebral artery injury 5 (blunt cerebrovascular injury, BCVI)
- extra-cranial cranial nerve injury 6
Radiographs will show asymmetry in the odontoid view with the displacement of the lateral mass(es) away from the odontoid peg (dens). A distance of greater than 6 mm suggests ligamentous injury.
CT demonstrates the fracture line which usually involves both the anterior and posterior arches. If there is an injury to the transverse atlantal ligament, the atlantodental interval (ADI) increases. The normal ADI in the adult population is less than 3 mm; in paediatric populations, the normal distance is less than 5 mm.
The fracture will not be seen as well as with CT. However, localised soft-tissue injury will be apparent. Pre-vertebral haemorrhage or oedema will identify injury at the level of C1/2. A ligamentous injury will also be demonstrated. A fat-sat T2 sequence is useful in the trauma setting to help distinguish abnormal soft-tissue injury from normal fat.
Treatment and prognosis
Jefferson fractures are typically treated conservatively (hard collar immobilisation) provided the transverse atlantal ligament is considered intact (no widening of the atlanto-dens interval or intact ligament visualised on MRI).
In cases where the ligament is thought to be disrupted, the injury is considered unstable and more aggressive management is usually required 7. This includes halo immobilisation, posterior C1-C2 lateral mass internal fixation or transoral internal fixation.
History and etymology
Named by Sir Geoffrey Jefferson (1886-1961), a neurosurgeon from the UK 4.
- 1. Lustrin ES, Karakas SP, Ortiz AO et-al. Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics. 23 (3): 539-60. doi:10.1148/rg.233025121 - Pubmed citation
- 2. Hunter TB, Peltier LF, Lund PJ. Radiologic history exhibit. Musculoskeletal eponyms: who are those guys? Radiographics. 20 (3): 819-36. Radiographics (full text) - Pubmed citation
- 3. Jefferson G. British Journal of Surgery. 1919;7 (27): 407-22 doi:10.1002/bjs.1800072713
- 4. Sir Geoffrey Jefferson from whonamedit.com, the dictionary of medical eponyms. Sir Geoffrey Jefferson
- 5. Muratsu H, Doita M, Yanagi T et-al. Cerebellar infarction resulting from vertebral artery occlusion associated with a Jefferson fracture. J Spinal Disord Tech. 2005;18 (3): 293-6. J Spinal Disord Tech (link) - Pubmed citation
- 6. Connolly B, Turner C, Devine J et-al. Jefferson fracture resulting in Collet-Sicard syndrome. Spine. 2000;25 (3): 395-8. Spine (link) - Pubmed citation
- 7. Norton JA, Barie PS, Bollinger R. Surgery, basic science and clinical evidence. Springer Verlag. (2008) ISBN:0387308008. Read it at Google Books - Find it at Amazon
- fractures by location
- cervical spine fracture classification systems
- thoracolumbar spinal fracture classification systems
- three column concept of spinal fractures (Denis classification)
- classification of sacral fractures
- facet dislocation