Jefferson fracture - fracture of the front and back arches of the first cervical vertebra . It is named after the British neurosurgeon , who first described him in 1920 [1] .
| Jefferson Fracture | |
|---|---|
| ICD-10 | S 12.0 |
| ICD-9 | 805.01 |
Content
Etiology
Jefferson's fracture can occur when falling from a height head down, hitting heavy objects on the head, falling and hitting the back of the head. Traumatic force leads to the expansion of the atlas osseous ring. The condyles of the occipital bone approach the articular processes of the epistrophy . In this case, the tooth-like process of the second cervical vertebra approaches the occipital bone. Its displacement anteriorly is favorable, posteriorly can cause compression of the spinal cord and brain stem [2] [3] .
Epidemiology
Practically not observed in children [4] . In the structure of traumatic injuries of the craniovertebral joint, atlant fractures account for 25%, 10% among fractures of the cervical spine and 2% among all injuries of the spine [3] .
Clinical symptoms
Patients complain of neck pain. The motionless position of the head is characteristic due to increased pain at the slightest attempt to make a movement. In a number of observations, patients support the head with their hands. On palpation, the primary localization of pain was noted in the posterior tubercle of the atlas [5] . After a year or more after the fracture, patients complain of bouts of headaches and dizziness, restriction of movements in the hands, crunching and pain in the back of the head with movements of the head, pain in the neck with radiation to the hands or head. This is because the unresolved displacement of the lateral masses and transverse processes of the atlas leads to the tension of the vertebral arteries passing through them. The formation of scar tissue in the region of the opening of the transverse processes in the late period forms a focus of pathological irritation of the vertebral arteries and the accompanying nerve structures with corresponding manifestations [6] . Blood supply disturbances may occur in the branch of the vertebral - with the development of Wallenberg-Zakharchenko syndrome . Damage to the sympathetic plexus that envelops the vertebral artery leads to the formation of Horner's syndrome [3] .
Diagnostics
In the diagnosis of Jefferson fractures, radiography , computed tomography and magnetic resonance imaging are used . On roentgenograms, the displacement of the lateral masses of the atlas outward is determined [7] . Computed tomography makes it possible to assess changes in bone structures, while magnetic resonance imaging - soft tissue [8] .
Treatment
There are various opinions in the scientific literature regarding the preferred treatment for Jefferson's fracture [9] . This largely depends on the stability or instability of the damage. If the transverse ligament of the atlas is damaged, the fracture will be unstable [10] . In case of stable injuries, the application of a cervical collar is necessary, while unstable ones may require additional traction and surgical intervention. Surgical treatment includes fixation of the upper cervical vertebrae and the occipital bone using special systems [9] .
Notes
- β Jefferson G. Fracture of the atlas vertebra: report of four cases, and a review of those previously recorded // Br J Surg. - Vol. 7, no. 27 . - P. 407-422. - DOI : 10.1002 / bjs.1800072713 .
- β Polishchuk N.E., Lutsik A.A., Ratkin I.K., Nikitin M.N. Part II. Damage to the spine and spinal cord. Chapter 1. Damage to the craniovertebral region // Damage to the spine and spinal cord / Ed. N. E. Polishchuk, N. A. Korzh, V. Ya. Fischenko. - K .: BOOK plus, 2001.
- β 1 2 3 Foster MR C1 Fractures . Medscape. Date of treatment June 22, 2015.
- β Korinth MC, Kapser AB, Weinzierl MR Jefferson Fracture in a Child - Illustrative Case Report (Eng.) // Pediatric Neurosurgery. - 2007. - Vol. 43, no. 6 . - P. 526-530. - ISSN 1423-0305 .
- β Lutsik, 1998 , p. 143-144.
- β Lutsik, 1998 , p. 158-157.
- β Lutsik, 1998 , p. 144.
- β Roy AK, Miller BA, Holland CM et al. Magnetic resonance imaging of traumatic injury to the craniovertebral junction: a case-based review // Neurosurgical Focus. - 2015. - Vol. 38, No. 4 .
- β 1 2 Hein C., Richter H.-P., Rath SA Atlantoaxial Screw Fixation for the Treatment of Isolated and Combined Unstable Jefferson Fractures - Experiences with 8 Patients // Acta Neurochir (Wien). - 2002. - Vol. 144, No. 11 . - P. 1187-1192. - DOI : 10.1007 / s00701-002-0998-2 . - PMID 12434175 .
- β Lee C., Woodring JH Unstable Jefferson Variant Atlas Fractures: An Unrecognized Cervical Injury ( Am ) // Am J Neuroradiol. - 1991. - Vol. 12. - P. 1105-1110. - PMID 1763734 .
Literature
- Lutsik A.A., Ratkin I.K., Nikitin M.N. Craniovertebral injuries and diseases. - Novosibirsk: Publisher, 1998 .-- 557 p. - ISBN 588399-003-7.