Question 3

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.


The first two are unstable, and the last one is stable.


comparison of clay shovelers hangmans and jeffersons c-spine fractures


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.