HWN Suggests

Cervical Spine Fractures: Snap, crackle, and Pop

Not surprisingly, young men, not known for their excellent decision making, make up most of the injuries, but older adults are also at risk after even minor trauma, especially with other risk factors such as osteoporosis or rheumatoid arthritis...

Not all fractures are made equal. Some are stable, others…. not so much. Common unstable fracture patterns can be remembered by the mnemonic Jefferson Bit Off A Hangman’s Thumb, standing for Jefferson fracture, Bilateral facet fracture, Odontoid fracture, Atlanto-occipital dislocation, Hangman’s fracture, and Teardrop fracture... All these fractures will obviously warrant a neurosurgery or spine surgery consult in your ED.

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Articles of Interest

C-Spine Injuries + CT Interpretation

Cervicocranial injuries (C1-C2) can be distinguished from lower cervical spine injuries (C3-C7). Cervicocranial injuries are classified by their anatomical location whereas lower cervical spine injuries are classified by their mechanism of injury (Schwartz 2008).

Cervical Spine Fractures

Jefferson, Hangman and Clay Shoveller fx.

Cervical Spine Fractures in Contact Sports

Unstable Cervical Spine Fracture. These types of fractures should be reduced quickly and stabilized temporarily with cervical traction using Gardner-Wells tongs or a halo ring device. A contrast-enhanced CT scan or MRI of the cervical spine may be obtained before fracture reduction to rule out the presence of retro pulsed intervertebral disk material. An unrecognized retro pulsed disk material has been implicated in the sudden neurological deterioration of patients undergoing a reduction of their cervical fractures. Therefore, surgical treatment is typically indicated for unstable cervical fractures.

Unstable Cervical Fractures

Here they are,,, Jefferson burst fracture - Axial loading force (diving) transmitted to C1 causing a bilateral fracture of the ring. Associated with other cervical fractures, vertebral aa injury.

Unstable Cervical Spine Fractures

The common mnemonic “Jefferson Bit Off A Hangman’s Thumb,” is used to remember the unstable fractures, which will be reviewed in this post.

Resources

Radiopaedia

Males are affected more commonly than females with a median age of injury of 56 years. Falls, motor vehicle collisions, pedestrian accidents, cycling and diving are common causes of injury

StatPearls

The cervical spine is a dynamic structure tasked with protecting nervous innervation to the entire body while also maintaining a range of motion for the head and neck. Fractures of the cervical spine are a leading cause of mobility and mortality in trauma patients, and a bone fracture is associated with 56% of cervical spinal cord injuries. Fractures of the cervical spine can be described based on the level involved and typically divided into three groups: C1, C2 and the sub-axial spine (C3 to C7).