Last pearl before our inservice tomorrow. Good luck to everyone. Hopefully this will buy you an additional point.


Jefferson Bit Off A Hangman’s Tit = Unstable cervical spine fractures


Jefferson Fracture

  • A burst fracture of the ring of C1
  • Typically caused by an axial loading force to the occiput (think diving injury)
  • Typically seen with odontoid view, bilateral, lateral offset of C1 on C2

jeffersonjefferson ct


Bilateral Locked Facets

  • Severe flexion injury causes subluxation of superior vertebral body forward by 50% compared to inferior vertebral body
  • Both anterior and posterior ligamentous structures disrupted
  • Typically occurs in lower cervical spine (seen on lateral view)

bit xr         bit ct

Odontoid Fracture

  • Fracture of the dens of the axis (C2)
  • Really type II (waist) and type III (incl c2 body) are unstable
  • Other fracture seen on Odontoid view (open mouth view)

off xr    off ct


Atlanta-occipital dislocation/subluxation

  • Typical fatal, basically head has detached from spine, <1% of injuries
  • More common in children given larger head size
  • Seen on lateral view


Hangman’s Fracture

  • Hyperextension injury (chin hitting dashboard/windshied in MVC)
  • Best seen on lateral view
  • Anterior dislocation of C2 vertebral body and bilateral C2 pars interartricularis fractures

Hangman   hangman plain film lateral

Teardrop Fracture

  • Hyperextension injury caused by the sudden pull of the anterior longitudinal ligament int he anterior/inferior aspect of the vertebral body (typically C2)
  • Best seen on lateral view

teardrop        teardrop ct