“Jefferson Bit Off A Hangman’s Thumb”

Jefferson Fracture

• C1 burst fracture - fracture of anterior and posterior arches 
• Often caused by axial loading 
• Approximately 50% associated with additional cervical spine fractures 

Bilateral Cervical Facet Dislocation 

• Rupture of the posterior ligamentous complex allows the superior facets to pass over inferior facets 
• Often caused by hyperflexion
• High risk for spinal cord injury 

Odontoid Fracture

• Fracture of dens/odontoid of C2
• Type II (transverse at base of odontoid) and Type III (through the body of the axis) are unstable, Type I (avulsion of the tip of the dens) is stable 
• Often caused by forceful flexion/extension 

Atlanto-occipital Dissociation 

• Aka internal decapitation - often fatal
• Disruption of all of the ligamentous connections between the occiput and atlas 
• More common in children 

Hangman’ Fracture 

• Fracture of bilateral pedicles of C2 with anterior displacement of C2 on C3
• Often caused by hyperextension 
• Commonly seen in MVCs and diving accidents, not in suicidal hangings
  

Flexion Teardrop Fracture

• Large triangular fragment off anterior portion of vertebral body
• Often caused by hyperflexion and compressive forces 
• Neurologic deficit common - either complete cord injury or anterior cord syndrome 

REFERENCE: Sherman, Scott.  Simon's Emergency Orthopedics.  8th edition.  New York, NY: McGraw-Hill Education LLC., 2019.