Facet joint dislocation, Jefferson and hangman fractures

Case contributed by Mr Andrew Murphy

Presentation

Jumped head first into water

Patient Data

Age: 18 years
Gender: Male

There is a fracture/dislocation at the C7/T1 junction. There is a C2 pars interarticularis fracture with no significant spondylolisthesis, some asymmetric widening of the C2/3 facet joints can be seen.

 

Traumatic fracture/dislocation of the cervicothoracic junction with grade 4 anterolisthesis of C7 on T1. There is bilateral locking of the C7/T1 facet joints.

Jefferson fracture of C1 evident via a two part fracture of the posterior arch.

Hangman's fracture of C2 is evident via bilateral C2 pars interarticular fractures with 3 mm anterolisthesis of C2 on C3.

Displaced C5 and C6 spinous process fractures.

Paravertebral haematomas anteriorly and laterally (on both sides) at T1-T2 levels extending below the scan field-of-view, and posterior to the C7 vertebral body extending behind the C6 vertebral body. The spinal cord is kinked at the C7 level and markedly oedematous, with ill-defined abnormal T2 signal extending from C4/C5 to T1/T2 level.

There are extensively comminuted fractures through the C2 vertebra, through the base of the odontoid process and both articular processes (extending to the transverse foramina) with abnormal widening of the C2/C3 facet joints (right more than left) suggesting disruption.  Minimally displaced fracture through the C1 posterior arch. No appreciable cord oedema at the C1-C2 levels or the craniocervical junction.  There is anterior epidural haemorrhage measuring up to 4mm in AP depth extending from C2 to C4/C5.

There is extensive prevertebral soft tissue swelling, and widespread oedema in and between the paravertebral muscles of the neck.

Case Discussion

Bilateral facet dislocations are an unstable spinal injury 1, further complicated in this case with a combination of a Jefferson and Hangman’s fractures. Reduction of this dislocation can be more complex with the presence of a perched or locked facet joint 2. Bilateral perched facet joints have a high rate of associated spinal cord injury; unfortunately, this was the result in this case. 

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Case Information

rID: 48836
Case created: 26th Oct 2016
Last edited: 20th Apr 2017
Systems: Trauma, Spine
Inclusion in quiz mode: Included

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