C1 Fractures: Jefferson Fracture and Atlas Fracture

A Jefferson fracture, or atlas fracture, is a bone break within the anterior and posterior arches of the C1 vertebra, named after the British neurosurgeon (Sir Geoffrey Jefferson) who wrote reports about the fracture in 1920. This type of C1 fracture stems from axial loading along the axis of the cervical spine. Axial loading occurs when the head and neck are flexed to approximately 30°. In this position, a key energy absorbing component of the spine is removed -the lordotic curve. When contact is applied to the crown of the head, the head reverses direction putting an extreme compressive load on the spine. When the force exceeds the spine’s absorption limit , the soft and hard tissue fails.  A C1 fracture is often accompanied by other C2 fractures, other C-spine injuries, or a head injury.

Causes of a Jefferson Fracture

Traffic accidents are the most common cause of Jefferson and C1 fractures. When a front-end collision propels an unrestrained passenger forward and the face or chin strikes the dashboard or steering wheel, it can result in the neck whipping upward and fracturing. Rollover accidents can also cause Jefferson fractures if the roof of the vehicle is crushed downward.

C1 fractures can also result from diving into shallow water, sports-related impacts, and falls. High-impact sports like football, cheerleading, skateboarding, and gymnastics involve the risk of C1 fractures. Gunshot wounds can also cause Jefferson fractures, if the bullet splinters the C- spine. Other neck compression injuries, such as a falling object striking you (a common type of injury in the construction injury), can also cause painful and dangerous C1 fractures.

Effects of a Jefferson Fracture

Jefferson fractures can appear as one, two, or three-part fractures from axial loads on the back of the head or hyperextension of the neck. A C1 fracture is a posterior break in the top of the spine, or the C1 vertebra. The top of the cervical spin is mobile and reliant on ligaments for stability. If an impact disrupts these ligaments, it can displace the head from the neck, resulting in a fracture of the dens.

A Jefferson fracture can be life threatening and potentially result in paralysis of everything below the point of injury—in this case, everything below the top of the spine. Jefferson fractures are fortunately somewhat rare, representing only about 2% of all spinal cord injuries. When an axial compression of the skull on the C1 vertebrae forces it onto the axis, it causes a rupture at the spine’s weakest points, resulting in lateral masses splitting.

When an object exerts pressure on the atlas, it only leads to an arch fracture, and the victim typically won’t suffer paralysis. Neurological damage is rare with C1 fractures. Jefferson fractures can be catastrophic if the spinal cord injury is “complete,” resulting in paralysis of all four limbs. This kind of fracture can result in respiratory problems and the inability to breath without a respirator or pacemaker. In turn, these problems can lead to infection, pneumonia, and other life-threatening complications.

Treatment and Prognosis

Doctors can treat the majority of minor Jefferson fractures without surgery. Treatment for minor fractures may use a Philadelphia cervical collar, halo brace, or Minerva cast to hold the head and neck in position during healing. These conservative treatments typically result in good outcomes, with the restoration of a full range of motion and no residual pain after about three to four months.

The use of surgery to treat Jefferson fractures is controversial, with many doctors believing non- surgical remedies will work over time. However, if the fracture is more severe or immobilization doesn’t stabilize the head and neck after three months, patients may need surgery—such as occiput-C2 wiring or spinal fusion. A Jefferson fracture may require fusion immediately after sustaining the injury if it’s unstable or involves ruptured ligaments. Fusion fixates the first three cervical vertebrae in place for stability and healing.

Although it’s a serious injury, the long-term prognosis for victims with Jefferson fracture is good, with no impact on physical abilities. If someone else’s negligence caused your Jefferson fracture, you may be eligible to receive compensation for your medical costs, pain and suffering, and mental anguish.

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