Fracture, jefferson

• 738.4 Acquired spondylolisthesis
• 756.12 Spondylolisthesis congenital
• 805.01 Closed fracture of first cervical vertebra

• 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

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

Description

• Anterior (forward) translation of a vertebra
• Fracture of the anterior and posterior arches of C1 vertebra
• Slipping of the vertebra in relationship to the vertebra below
• Ataxia
• Fracture widens at the pars

Essentials of Diagnosis

• Diagnosis made by x-ray
• 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

Signs and Symptoms

• Ataxia
• Injury to vertebral artery
• Cervical, shoulder, arm, upper-extremity pain; often radiating into lower extremities if central cord involved
• Constricted pupil (Horner’s sign)
• Stiffness along spine
• Headaches
• Pain in 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

Differential Diagnosis

• Peripheral nerve impairment
• Spinal tumor
• Peripheral neuropathy
• Paraspinal spasms
• Degenerative disk disease
• Hangman’s fracture
  • C2 vertebra anterior translated on C3 with fracture of C2 pedicles

Imaging

• MRI helps to visualize compressed or inflamed nerve root in diagnosis
• X-ray/plain-film radiograph to see vertebra position
• CT to show herniation compressing the spinal canal/nerves
• Electrodiagnostic/nerve conduction testing can help to determine a specific impaired nerve function

• Fracture of the anterior and posterior arches of C1 vertebra

• To hospital for imaging
• To surgeon for surgical consult if myelopathy suspected
  • Fusion
• To physician for anti-inflammatory medication
• To orthopedist for halo vest traction device, cervical bracing

• Restricted mobility of the upper cervical spine
• Hypermobility
• Noted weakness of neck musculature

• Rest
• Bracing
• Address pain
  • Electrical stimulation
  • Heat/ice
• Address hypertonicity
  • Soft tissue massage
  • Heat
• Address muscle weakness
  • Stability exercises

• Patient will be able to
  • Sit with neutral cervical-spine posture for greater than 30 minutes with 0 out of 10 pain rating
  • Stand at work station and perform computer work for 45 minutes with 0 out of 10 pain rating
  • Rotate cervical spine 75 degrees ...