0:01

I like this diagram because it shows the different

0:04

varieties of C1 vertebral fractures.

0:08

The ones that I've shown so far have been the Jefferson burst

0:12

fractures which have portions of the anterior and posterior arch

0:17

of C1. And they show the mechanism here by axial loading.

0:21

Here we have lateral mass fracture,

0:23

just unilateral fracture.

0:25

And this can occur with axial loading and rotation.

0:29

Here the anterior arch of C1 fracture,

0:33

axial loading with flexion and then the posterior arch

0:37

of C1 fracture with axial loading and extension.

0:40

So this is posterior, this is anterior

0:42

on this diagram. On our CT scan,

0:45

which is on our anatomic diagram,

0:47

you see that there is fracture both of the anterior

0:50

arch as well as the posterior arch.

0:53

So the combination of the two represents the

0:56

burst fracture, the Jefferson fracture.

0:58

Here you have anterior arch extending into the lateral mass.

1:02

So it's both the anterior arch as well as the lateral mass.

1:06

And here you see the fracture across posterior arch.

1:10

So this is a combination of the Jefferson fracture

1:13

with a lateral mass fracture as well.

1:17

And you can see again the offset of the lateral mass to

1:22

the odontoid process lateral mass.

1:24

So this is C1.

1:25

This is C2 lateral offset implying potential instability

1:30

and or ligamentous injury that can occur.

1:33

So the stability depends really on this transverse ligament.

1:36

Remember that the transverse ligament goes across the back

1:39

of the odontoid process and attaches to the C1 lateral

1:43

masses and across. And that is creating the stability of C1,

1:49

C2 to each other.

1:51

Now, along with the C1 fractures,

1:55

we more commonly see odontoid fractures.

1:58

I believe that odontoid fractures and clay shoveler's

2:02

fractures are the two most common cervical spine fractures.

2:06

The odontoid fractures are separated by the classification

2:10

showing Type I just at the tip of the odontoid process.

2:14

Type II at the base,

2:15

but not extending into the vertebral body.

2:18

And then the Type III extending into

2:21

the vertebral body of the C2.

2:24

And I showed you one that was kind of close.

2:27

It was just at the neck of the odontoid process,

2:30

but did seem to extend into the C2 body.

2:35

So you may blur the margins here between them with Type II and

2:40

Type III, depending upon how deep it

2:42

goes into the vertebral body of C2.

2:46

Here you can see a fracture which extends not into

2:50

the vertebral body, at least on the plane films.

2:53

Here you can see it again right across here,

2:56

representing the Type II odontoid fracture.

3:00

Notice that there is just a slight bit of offset posteriorly

3:04

of the superior fracture fragment from the

3:07

inferior fragment of the C2 body.

Case 27 - Jefferson's Burst Fracture: Summary

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