TY - JOUR
T1 - Case report
T2 - Nonoperative treatment of an unstable Jefferson fracture using a cervical collar
AU - Haus, Brian
AU - Harris, Mitchel B.
PY - 2008/5
Y1 - 2008/5
N2 - The treatment of unstable burst fractures of the atlas (Jefferson fractures) is controversial. Unstable Jefferson fractures have been managed successfully with either immobilization, typically halo traction or halo vest, or surgery. We report a patient with an unstable Jefferson fracture treated nonoperatively with a cervical collar, frequent clinical examinations, and flexion-extension radiographs. Twelve months after treatment, the patient achieved painless union of his fracture. The successful treatment confirms prior studies reporting unstable Jefferson fractures have been treated nonoperatively. The outcome challenges the clinical relevance of treatment algorithms that rely on the "rules of Spence" to guide treatment of unstable Jefferson fractures and illustrates instability may not necessarily be present in patients with considerable lateral mass widening. Additionally, it emphasizes a more reliable way of assessing C1-C2 stability in unstable Jefferson fractures is by measuring the presence and extent of anterior subluxation on lateral flexion and extension views.
AB - The treatment of unstable burst fractures of the atlas (Jefferson fractures) is controversial. Unstable Jefferson fractures have been managed successfully with either immobilization, typically halo traction or halo vest, or surgery. We report a patient with an unstable Jefferson fracture treated nonoperatively with a cervical collar, frequent clinical examinations, and flexion-extension radiographs. Twelve months after treatment, the patient achieved painless union of his fracture. The successful treatment confirms prior studies reporting unstable Jefferson fractures have been treated nonoperatively. The outcome challenges the clinical relevance of treatment algorithms that rely on the "rules of Spence" to guide treatment of unstable Jefferson fractures and illustrates instability may not necessarily be present in patients with considerable lateral mass widening. Additionally, it emphasizes a more reliable way of assessing C1-C2 stability in unstable Jefferson fractures is by measuring the presence and extent of anterior subluxation on lateral flexion and extension views.
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U2 - 10.1007/s11999-008-0143-5
DO - 10.1007/s11999-008-0143-5
M3 - Article
C2 - 18259828
AN - SCOPUS:44649201505
VL - 466
SP - 1257
EP - 1261
JO - Clinical Orthopaedics and Related Research
JF - Clinical Orthopaedics and Related Research
SN - 0009-921X
IS - 5
ER -