Anatomy Msk · Year 1 · from Anatomy Msk
Case 3: Cervical Spine Fracture
Clinical Image
Source: Wikimedia Commons - Jefferson Fracture - CC BY-SA 3.0
Case Presentation
A 24-year-old man is brought to the trauma center by EMS after diving into a shallow pool and striking his head on the bottom. He was found floating face-down and pulled from the water by bystanders. He is awake and alert but immobilized on a backboard with cervical collar in place. He reports severe neck pain but denies extremity weakness or numbness. Physical examination, maintaining cervical immobilization, reveals midline cervical tenderness at the upper cervical region. He has full strength in all extremities, intact sensation, and normal reflexes. CT cervical spine reveals a burst fracture of C1 (Jefferson fracture) with lateral mass displacement, as well as an associated C2 (axis) fracture through the base of the odontoid (type II dens fracture). MRI shows no spinal cord injury or ligamentous disruption. The patient is placed in a halo vest for immobilization. After 3 months, follow-up imaging shows adequate healing, and the halo is removed. This case demonstrates the vulnerability of the upper cervical spine to axial loading injuries.
Key Learning Points
- The atlas (C1) and axis (C2) are atypical vertebrae with unique articulations allowing rotation and nodding
- Jefferson fracture is a burst fracture of the C1 ring from axial loading (diving, falls on head)
- Odontoid (dens) fractures are classified by location: Type I (tip), Type II (base, most common), Type III (into C2 body)
- Type II dens fractures have highest nonunion rates due to limited blood supply at the base
- The atlantoaxial joint is stabilized primarily by the transverse ligament of the atlas, which holds the dens against the anterior arch