Presentation
Attempted hanging
Patient Data
There is a two-part fracture of the C1 ring involving the anterior arch on the left and the posterior arch on the right. There is diastasis at the fracture site anteriorly and mild lateral displacement of the fracture component on the right. Subtle minimal offset of the C1 lateral masses relative to the C2 lateral margins is noted. No bone avulsion noted at the transverse ligament attachment or widening of the atlantoaxial interval. Mild adjacent prevertebral soft tissue swelling is seen.
Case Discussion
A Jefferson fracture of C1 often results from some form of vertical compression and results in a 2 or more part fracture of the ring. It is important to look for signs of transverse ligament injury (widening of the atlantoaxial interval, bone avulsion at attachment site, ligament tear on MRI) which indicates unstable injury. It can be associated with fractures of the axis or noncontiguous cervical vertebra.
Case co-author: Rehana Jaffer MD, FRCPC
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