1/21/2024 0 Comments Jefferson fracture types![]() Occipitocervical dislocations can be classified according to the direction of displacement of the occiput with regard to C1 in anterior (type 1), vertical (distraction, type 2), and posterior (type 3) plane. Any occipital condylar fracture associated with craniocervical dissociation is unstable.Ĭraniocervical dissociation is considered unstable with translation or distraction > 2 mm in any plane. Type 3 fractures are unstable avulsion injuries secondary to rotation and lateral bending, presenting with a transverse fracture line through the occipital condyle ( Fig. Type 2 injuries are potentially unstable injuries caused by a shear mechanism that results in an oblique fracture extending from the condyle into the skull base. Type 1 is an impacted comminuted condylar fracture with minimal displacement secondary to axial loading. Occipital condyle fractures were classified into three types by Anderson and Montesano. Differentiation between stable and unstable cervical spine injuries is of utmost importance ( Table 15.5). Patients with any neurological deficit or unstable fracture patterns (damage to the posterior ligaments) will need surgical fixation to decompress the spinal cord and stabilize the fracture 5. If immobilization is impractical (large body habitus) or the patient has polytrauma, surgical management may also be indicated.Cervical (C) spine injuries are caused by hyperflexion (e.g., anterior wedge or compression fracture, teardrop fracture, anterior subluxation, and bilateral jumped facets with anterior subluxation of the superior vertebra), hyperextension (e.g., avulsion anteroinferior corner of a vertebral body, typically at C2, or C3, and hangman’s fracture), hyperrotation (e.g., rotary atlantoaxial subluxation), hyperflexion and rotation (e.g., unilateral jumped facet), lateral hyperflexion (e.g., unilateral pillar fracture), and vertical compression (e.g., Jefferson fracture and burst fractures C3–C7). It should be noted that patients managed non-operatively need long term follow-up to ensure they do not develop any kyphotic deformity. Non-surgical management may be suitable for patients with no neurological defects and stable posterior elements 5. Treatment is broadly classified into non-surgical management with a stabilizing brace or orthotic or surgical management, usually by posterior fusion +/- anterior fusion. Useful to assess for ligamentous injury and cord injury More accurately delineates fracture details Widening of the facet joints and increased intercostal spacing Widening of the interpedicular distance: often suggests a burst component Transverse fractures across the transverse processes, laminae, and articular processes Plain radiographĮmpty vertebral body sign: can be seen on an AP radiograph and results from the vertical separation of the posterior elements displacing the spinous processes or spinous process fracture fragments of the vertebral body on the AP projection ![]() If unrecognised, Chance injuries may result in progressive kyphosis with resulting pain and deformity.Īnterior wedge fracture of the vertebral body with a horizontal fracture through posterior elements or distraction of facet joints and spinous processes. Associated intra-abdominal injuries appear to be more common in the pediatric age group with an incidence approaching 50%. There is a high incidence of associated intra-abdominal injuries (especially the pancreas and duodenum) that can result in increased morbidity and mortality. This fracture most commonly occurs about the upper lumbar spine (with the thoracolumbar junction accounting for ~50% of cases 3), but it may be observed in the mid lumbar region in children. ![]() ![]() Bones often fracture before the ligaments because the ligaments have higher tensile strength than the bones 1. Thus, the anterior and middle columns fail in compression (moving together or in "flexion"), and the posterior column fails in distraction (moving apart). Therefore, the spine tears apart in a horizontal fracture into the upper and lower parts. ![]() The fracture typically occurs where the fulcrum is the seatbelt and the point of motion is the spine itself. Chance fracture is also known as the "seatbelt fracture". ![]()
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