Jefferson fracture
| Classification according to ICD-10 | |
|---|---|
| S12.0 | Fracture of the 1st cervical vertebra (atlas) |
| ICD-10 online (WHO version 2019) | |
A multiple fracture of the 1st cervical vertebra ( atlas ) is called a Jefferson fracture .
Described in 1920 by Sir Geoffrey Jefferson in his work "Fracture of the atlas vertebra: report of four cases, and a review of those previously recorded" , it occurs in the classical form as a fourfold fracture (double-sided fracture of the posterior and anterior atlas arches).
Only about 1–2% of all spinal fractures are fractures of the atlas, of which about a third are classic Jefferson fractures with 4 fracture fragments. The cause is an axial (longitudinal, in the longitudinal direction of the spine) acting force on the skull , which is transmitted via the lateral condyles , ruptures the atlas ring at its weakest points, pushes the fragments outward and leads to the rupture of the transverse atlantic ligament . Often this happens in swimming accidents by diving into shallow water.
Post- accident neck pain and headache in the occipital area should draw attention to a fracture of the atlas. Neurological deficits (entrapment of the spinal cord and / or medulla oblongata ) occur in isolated Jefferson fractures only in exceptional cases, as the spinal canal expands as the atlas arches diverge. However, swallowing disorders as a result of a paravertebral hematoma can occur. Strokes as a result of dissection of the vertebral or carotid artery (s) or damage to the lower cranial nerves (IX-XII) are also possible, but rare in isolated Jefferson fractures . Radiological confirmation is provided by means of an open mouth Dens target exposure and computed tomography .
Sometimes a Jefferson fracture is associated with other fractures of the cervical vertebrae or the base of the skull, especially after high-energy trauma. The most common are fractures of the axis (dens-axis fracture, hangman fracture). In these cases, more neurological complications and a poorer prognosis (up to and including death) can be expected.
This severe fracture of the head joint is treated with a halo fixator and joint stiffener .
Individual evidence
- ^ Fracture of the atlas vertebra: report of four cases, and a review of those previously recorded. In: British Journal of Surgery . London 1920, 7, pp. 407-422.
- ↑ medm.de: S12.0 fracture of the 1st cervical vertebra / atlas ring fracture / C1 ring fracture ( page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.
- ↑ https://radiopaedia.org/articles/jefferson-fracture ; accessed on May 18, 2018
- ↑ https://radiopaedia.org/articles/jefferson-fracture ; accessed on May 18, 2018
- ^ Doris Henne-Bruns: Dual series surgery. 3rd, completely revised and exp. Edition. Thieme, Stuttgart 2008, ISBN 978-3-13-125293-7 , p. 821.
