Review Question - QID 4615

The patient has sustained a Jefferson fracture of the C1 arch. Given that the transverse ligament is intact, of the options listed, a rigid collar orthosis for 6-12 weeks would be the most appropriate treatment.

Fractures of the atlas are often the result of hyperextension, lateral compression and axial compression. Type 2 atlas fractures (Jefferson burst) involve the anterior and posterior arches as a result of axial loading. The stability and treatment of these fractures depends on the integrity of the transverse ligament.

Dickman et al. reviewed 39 patients with injury to the transverse ligament or its bony origins. They recommend that ligamentous (Type 1) injuries be treated with early surgery where as bony ligamentous avulsion (Type 2) injuries be treated initially with a hard cervical orthosis. Type 2 injuries had a 74% success rate of healing with conservative measures.

Spence et al. report a case of an atlas fracture with an associated injury to the transverse ligament. They indicate that lateral mass displacement greater than 6.9 mm is likely indicative of a tear in the transverse ligament. They recommend use of radiographs to delineate the integrity of the transverse ligament, as this will help guide treatment.

Illustration A shows an axial CT cut of a Jefferson fracture. The posterior arches are bilaterally fractured with unilateral involvement of the anterior arch.

Incorrect Answers
Answer 1: Observation is not indicated in this situation.
Answers 2, 3: In a Jefferson type injury, a soft collar orthosis is not indicated
Answer 5: Given the integrity of the transverse ligament, a posterior cervical fusion is not indicated at this time.