Jefferson fracture

A Jefferson fracture is a bone fracture occurring at the first vertebrae. It is classically described as a four-part break that fractures the anterior and posterior arches of the vertebra,^[1] though it may also appear as a three or two part fracture. The fracture may result from compression of the second vertebra or hyperextension of the neck, causing a posterior break, and may be accompanied by a break in other parts of the cervical spine.^[1]

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 previous cases that had been reported previously.^[2]

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Etiology

  Jefferson fractures are often caused by an impact or load on the back of the head, and are frequently associated with diving into shallow water, impact against the roof of a vehicle and falls,^[3] and in children may occur due to falls from playground equipment.^[4] Less frequently, strong rotation of the head may also result in Jefferson fractures.^[3]

Jefferson fractures are extremely rare in children, but recovery is usually complete without surgery.^[4]

Symptoms

Individuals with Jefferson fractures usually experience pain 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.^[1]

In rare cases, congenital abnormality may cause the same symptoms as a Jefferson fracture.^[5][6]

Treatment

The use of surgery to treat a Jefferson fracture is somewhat controversial.^[7] 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.^[8][1] 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.^[9] Surgical treatment of a Jefferson fracture involves fusion or fixation of the first three cervical vertebrae;^[7][1] fusion may occur immediately, or later during treatment in cases where non-surgical interventions are unsuccessful.^[7] A primary factor in deciding between surgical and non-surgical intervention is the degree of stability^[7][9] as well as the presence of damage to other cervical vertebrae.^[9]

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.^[10] Conservative treatment with an immobilization device can produce excellent long-term recovery.^[11][12]

References