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125: JEFFERSON FRACTURE

Eric Shamus, PhD, DPT, PT, CSCS; Melissa Tabor, DO

ICD-9-CM CODES

  • 738.4 Acquired spondylolisthesis

  • 756.12 Spondylolisthesis congenital

  • 805.01 Closed fracture of first cervical vertebra

ICD-10-CM CODES

  • M43.10 Spondylolisthesis, site unspecified

  • Q76.2 Congenital spondylolisthesis

  • S12.000A Unspecified displaced fracture of first cervical vertebra, initial encounter for closed fracture

  • S12.001A Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for closed fracture

PREFERRED PRACTICE PATTERN

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1

PATIENT PRESENTATION

Patient is a 36-year-old construction worker who fell off a ladder and had a burst fracture of the atlas. The physician and patient decided to treat the fracture with immobilization with halo traction and halo vest. Patient achieved a union of his fracture. The patient presents with increased tone bilateral upper trapezius and scalenes with decreased range of motion of the cervical spine.

KEY FEATURES

Description

  • Anterior (forward) translation of a vertebra

  • Fracture of the anterior and posterior arches of the C1 vertebra

  • Slipping of the vertebra in relationship to the vertebra below

  • Ataxia

  • Fracture widens at the pars

  • Typically a four-part or “burst” fracture

Essentials of Diagnosis

  • Diagnosis made by X-ray, children may require CT scan

  • Clinical examination may find step deformity

  • Axial load on top of the head

  • Reports diving into a shallow pool

General Considerations

  • Instability

  • Avoid extension positions that increase symptoms

Demographics

  • Usually from landing on head, as with diving into a shallow pool

FIGURE 125-1

Axial CT demonstrates four fracture lines (arrows) separating C1 in four parts. Jefferson fracture is usually caused by axial impact to the head such as diving in shallow water. (From Longo DL, Fauci A, Kasper D, et al., eds. Harrison’s Principles of Internal Medicine. 18th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Ataxia

  • Injury to vertebral artery

  • Cervical, shoulder, arm, and upper-extremity pain; often radiating into lower extremities if central cord involved

  • Constricted pupil (Horner sign)

  • Stiffness along spine

  • Headaches

  • Pain in the cervical spine worsens with extension

Functional Implications

  • Difficulty maintaining standing postures secondary to neck pain

  • Difficulty with movements (reaching overhead) secondary to pain

  • Limited sports participation

  • Can cause quadriplegia or death

Possible Contributing Causes

  • Forceful extension from hit under the chin (as in sports)

  • Car accident, hit from rear

  • Hyperextension of the cervical spine

  • Diving into a shallow pool

FIGURE 125-2

Jefferson fracture CT and radiographs show a Jefferson burst fracture in ...

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