Outline  the differences  between  a Jefferson  fracture, Hangman’s fracture and  Clay- shoveller’s fracture.

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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:

comparison of clay shovelers hangmans and jeffersons c-spine fractures

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.