Question 3
Outline the differences between a Jefferson fracture, Hangman’s fracture and Clay- shoveller’s fracture.
College Answer
Jefferson fracture: burst fracture of the atlas (C1); usually combined anterior and posterior arch fractures; results from axial compression of C1 in circumstances such as diving into water head first or being thrown against the roof of a car or aircraft; may also result from hyperextension causing a posterior arch fracture. Unstable.
Hangman’s fracture: bilateral fracture of the posterior arch of C2 and disruption of the C2-3 junction; neurological injury may result from damage to the posterior longitudinal ligament allowing significant anterior displacement of C2 on C3; results from C-spine hyperextension with vertical compression of the posterior column eg. a car accident victim’s head striking the dashboard. Unstable.
Clay-shoveller’s fracture: fracture of one or more of the spinous processes of the C6-T3 vertebra; it is an avulsion fracture by the supraspinous ligament of the spinous process caused hyperflexion. Stable.
Discussion
The first two are unstable, and the last one is stable.
Observe:
References
Thompson, Wendy L., et al. "Association of injury mechanism with the risk of cervical spine fractures." CJEM 11.1 (2009): 14-22.
Pimentel, Laura, and Laura Diegelmann. "Evaluation and management of acute cervical spine trauma." Emergency medicine clinics of North America 28.4 (2010): 719-738.