# EMCONF : Unstable Cervical Spine Injuries


Jefferson Bit Off 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.