C1 Fractures (Jefferson)

FACTS

  • often called “Burst fractures of C1”
Gehweiler Type
Description
Stability
Typical Management
1
Isolated anterior arch fracture (usually from hyperextension)
Stable
Rigid cervical collar for 6–8 weeks
2
Isolated posterior arch fracture (often bilateral from hyperextension)
Stable
Rigid cervical collar immobilization; heals well
3
Jefferson (burst) fracture involving both anterior and posterior arches — often 4-part fracture from axial loading
TAL intact: stable
TAL ruptured: unstable
- TAL intact: rigid collar or halo vest- TAL ruptured: posterior C1–C2 fusion or occipito-cervical fusion
4
Lateral mass fracture of C1 (unilateral or bilateral)
Potentially unstable depending on displacement and TAL injury
- Minimal displacement: collar or halo- Marked displacement (>7 mm): surgical fixation (C1–C2 fusion)
5
Transverse (sagittal split) fracture through anterior and posterior arches
Unstable
Posterior C1–C2 fusion recommended

HPI

universal trauma history

PHYSICAL EXAM

universal exam

IMAGING

CT C-spine w/o contrast:
  • if lateral masses displaced > 7 mm, likely TAL injury
MRI C-spine w/o contrast with 3D T2 STIR through O-C2
  • evaluate for integrity of TAL on T2 stir
A/P