JEFFERSON'S FX

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A Jefferson's FX is a result of a burst fracture to the closed ring of C1 (atlas). A Jefferson's FX most commonly results in at least 2 fractures of C1 because of the anatomical structure being a ring. These FX's often occur as a result of an axial loading impact to the skull.

There are three impact injuries that are responsible for the majority of all Jefferson FX's.

1-Diving into shallow water and hitting on head

2 -Hitting on head of roof of motor vehicle during an MVA

3 - Falls that result in landing on head

Depending on the injury, and the amount of impact on the head other additional injuries can accompany a Jefferson's FX.

1 - C2 FX

2 - Vertebral artery damage

3 - Cranial nerve defects in V, IX, X, and XI

4 - atlantooccipital dislocation

5 - transverse ligament fracture

Pt's who have a Jefferson's FX will present with neck pain, as a result of an injury. It is common for most all neck pain pt's to present with these symptoms; however, it is vital to rule out a Jefferson's FX promptly before any neurologically damage occurs as a result of an untreated Jefferson's FX. If a pt presents, and is positive for a Jefferson's FX and does have substantial neurological deficits. They will need to have a tracheostomy place to assist with respiratory needs.

Once a Jefferson's FX has been confirmed, and the severity of the FX has been decided, a

decision on the treatment that needs to take place is the next vital step for these patients

Depending on the severity of any additional symptoms in patients with Jefferson's FX, treatment then varies accordingly.

The first steps of treatment occur at the site of the injury. Airway, breathing, and circulation must first be assessed prior to moving the patient. If the airway and breathing are not working sufficiently - intubation must be performed without movement of the C-spine. At this point, it is also important to remember that these patients may have suffered a concussion or may be in shock and unable to report any neck pain. To be safe, it is a must to treat all patients as if there might be a spinal cord injury of some sort.

Next, cervical spine radiographs need to be performed in the ER. Usually this is a x-table lateral c-spine film to evaluate the alignment of the odontoid complex in relation to the remaining c-spine vertebra. This view is best to r/o any anterior dislocation. The odontoid view is also necessary to image to symmetry of the odontoid projection between the lateral masses of C2. If a lateral disruption overhangs the masses by more than 6.9mm a C1 FX is a established. Lastly, a CT may be used in addition to verify the Jefferson's FX with thin axial slices through the level of the base of the skull through C2. Angiography may also be needed to evaluate any vertebral vessel involvement.

The most common way to treat a Jefferson's FX is with a surgical fixation of a Halo collar and/or vest. This is the best way to provide for stable and reliable healing process. Depending on any other cervical spine resulting injuries, determines how/where the Halo/Vest will be fixated. The should be maintained safely in a structured stability collar until time of surgery. Traction is not recommended due to the risk of spinal cord damage. Once the patient is in the OR, it is vital to keep the neurological function of the patient monitored in order to verify that no additional injury has occurred. Post operatively, the patient will remain in the Halo for 8-12 weeks. They also should regularly be monitored with radiographs to verify the healing process.

http://emedicine.medscape.com/article/1263453-diagnosis