A Nonsurgical Solution: Jefferson (Burst) Fracture

Tay, Shee Yen; Li, Chia Wei; Ko, Chih Hsiang; Chan, Wing P.

doi:10.1016/j.amjmed.2018.05.018

Cited by 5 publications

(6 citation statements)

References 5 publications

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“…Surgery advocates have argued that these surgical techniques to fix fractures are preferable since conservative treatments result in delayed atlantoaxial instability, craniovertebral settling, a high nonunion rate, and late neurological sequelae [ 7 , 21 , 22 ]. On the other hand, advocates of conservative management have reported that unstable atlas fractures can be managed by HVI or rigid collars [ 10 , 11 , 23 ]. They argued that HVI or a rigid collar provides traction to align the fractured lateral masses by ligamentotaxis effect and reduces a stress force below C1–2, thereby preventing subluxation and promoting healing [ 11 , 19 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…7,21,22 On the other hand, advocates of conservative management have reported that unstable atlas fractures can be managed by HVI or rigid collars. 10,11,23 They argued that HVI or a rigid collar provides traction to align the fractured lateral masses by ligamentotaxis effect and reduces a stress force below C1-C2, thereby preventing subluxation and promoting healing. 11,19,23 However, it is doubtful whether the damaged TAL of an unstable atlas fracture can facilitate ligamentotaxis and maintain a lateral slippage until complete healing.…”

Section: Outcomes Between Patients Who Underwent Surgical Operation A...mentioning

confidence: 99%

“…However, some researchers have reported that unstable atlas fractures with TAL rupture can be successfully managed by non-operative treatment. 10,11 According to Dickman's suggestion, an atlas avulsion fracture with transverse ligament rupture could be managed by external immobilization, such as a rigid brace or a halo-vest device.…”

Section: Introductionmentioning

confidence: 99%

“…Nonoperative management with halo-vest immobilization (HVI) or cervical braces often results in nonunion of C1–2, persistent neck pain, pin site loosening, abscess formation, or late atlantoaxial instability. However, some researchers have reported that unstable atlas fractures with TAL rupture can be successfully managed by nonoperative treatment [ 10 , 11 ]. According to Dickman’s suggestion, an atlas avulsion fracture with transverse ligament rupture could be managed by external immobilization, such as a rigid brace or a halo-vest device.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study

et al. 2022

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Objective: This multicenter study compared radiological parameters and clinical outcomes between surgical and non-surgical management and investigated treatment characteristics associated with the successful management of unstable atlas fractures. Methods:We retrospectively evaluated 53 consecutive patients with unstable atlas fracture who underwent halo-vest immobilization (HVI) or surgical fixation. Clinical outcomes were assessed using neck visual analog scale and disability index. The radiological assessment included total lateral mass displacement (LMD) and the anterior atlantodental interval (AADI).Results: Thirty-two patients underwent surgical fixation and 21 received HVI (mean follow-up, 24.9 months). In the surgical fixation, but not in the HVI, LMD and AADI showed statistically significant improvements at the last follow-up. The osseous healing rate and time-to-healing were 100% and 14.3 weeks with surgical fixation, compared with 71.43% and 20.0 weeks with HVI, respectively. Patients treated with HVI showed poorer neck pain and neck disability outcomes than those who received surgical treatment. LMD showed an association with osseous healing outcomes in non-operative management. Clinical outcomes and osseous healing showed no significant differences according to Dickman's classification of TAL injuries.Conclusion: Surgical internal fixation had a higher fusion rate, shorter fracture healing time, more favorable clinical outcomes, and a more significant reduction in LMD and AADI compared to nonoperative management. The pitfalls of external immobilization are inadequate maintenance and a lower probability of reducing fractured lateral masses. Stabilization by surgical reduction with interconnected fixation proved to be a more practical management strategy than non-operative treatment for unstable atlas fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Outcomes Between Patients Who Underwent Surgical Operation A...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study

et al. 2022

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“…1 Posttraumatic injury to the lower four cranial nerves (IX-XII) has also been described in case reports (Collet-Sicard Syndrome). 1,7 Vertebral artery injury can also occur and lead to cerebrovascular accidents. 2,8 Prognosis of atlas fractures is in large part dependent on spinal stability, which is supported by the classification of injury.…”

Section: Discussionmentioning

confidence: 99%

Jefferson Fracture and the Classification System for Atlas Fractures, A Case Report

Martinez-Romo¹,

McCoy²

2021

Journal of Education and Teaching in Emergency Medicine

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The Jefferson fracture classification system describes fractures of the atlas (first cervical vertebra or C1). Jefferson fractures with potential tears in the transverse ligament can cause cervical spine instability and can result in neurologic injury if not appropriately diagnosed and managed. We present the case of a 54year-old man who fell head first with cervical spine tenderness and upper extremity paresthesias. The patient's Jefferson fracture was diagnosed via computed tomography. The patient was then treated nonoperatively for his Jefferson fracture, and he had an unremarkable hospitalization. Emergency physicians should obtain surgical consultation and consider the possibility of ligamentous injury in patients suffering injury to the cervical spine.

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Comparison of radiological and clinical outcomes after surgical reduction with fixation or halo-vest immobilization for treating unstable atlas fractures

Kim

Shin

2019

Acta Neurochir

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A Nonsurgical Solution: Jefferson (Burst) Fracture

Cited by 5 publications

References 5 publications

Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study

Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study

Jefferson Fracture and the Classification System for Atlas Fractures, A Case Report

Comparison of radiological and clinical outcomes after surgical reduction with fixation or halo-vest immobilization for treating unstable atlas fractures

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