Mechanism Vertical Compression Injuries

BURST FRACTURE OF THE LOWER CERVICAL SPINE A direct axial load causes a burst fracture of the lower cervical spine. The axial force causes the vertebra to burst with fragments displacing in all directions (.Fig .264:1.1). The spinal cord may be injured if a fragment enters the spinal canal. The lateral radiograph may show a fracture of the superior and inferior vertebral end plate and retropulsion of the posterior segment of the vertebra into the spinal canal. The AP view will show a vertical fracture and widening of the interpedicular distance. This injury is unstable. Immediate consultation is recommended. 16

JEFFERSON FRACTURE The Jefferson fracture is usually produced when the cervical spine is subjected to an axial load due to a direct blow to the top of the head.

The occipital condyles are displaced downward and produce a burst fracture by driving the lateral masses of C1 apart ( Fig 264:12). The lateral masses will be displaced laterally on the open-mouth odontoid radiograph. A fracture through only one lateral mass will cause unilateral displacement on the open-mouth view. Instability is likely if the lateral masses are displaced significantly. If the displacement of the lateral masses on each side added together is greater than 7 mm, rupture of the transverse ligament is likely. Immediate specialist consultation is necessary for all Jefferson fractures.

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