C1, C2 Fractures



Unstable Fractures of the C-Spine
Jefferson fracture
(C1 burst fx)
Axial load with vertical compression Football player spearing another player Seen on odontoid view
Bilateral facet dislocation Flexion Although called locked facets the injury is unstable Anterior displacement > 50% diameter of vertebral body.
Odontoid type II/III Flexion Severe high cervical pain or pain radiating to the occiput Usually due to major forces Consider other C-spine and bodily injuries.
Atlantoaxial or atlanto-occipital dislocations Flexion or extension   Atlanto-occipital dissociation usually results in death.
Hangman's fracture (bilateral C2 pedicle fx) Extension; C2 displaced anteriorly on C3 Judicial hanging with ball of noose in front Not common with suicide hangings
Teardrop fracture Flexion or extension
(an avulsion fracture)
  The teardrop is the anteroinferior portion
of the vertebral body.
Instability increases with multicolumn injuries.
Markers of unstable C-spine injury include damage to anterior 20% of vertebral body and loss of >50% of body height.