Jefferson fracture, anterior displacement of C-1

Case #54: Plain films: Jefferson Fx, anterior displacement C1

CC: Loss of consciousness and fall.

HX: This 37 y/o male had an extensive history of alcoholism (multiple inpatient courses of ETOH rehab). He had been on a five day drinking binge when he fell off a bar stool and struck his occiput on the floor. Bystanders reported LOC, but the duration was unclear. Prior to the fall, the patient was observed to have struck himself several times about the head with an empty liquor bottle. Following the fall, he was taken to an local ER where cervical spine plain films identified a possible fracture. The neurologic exam was reportedly unremarkable, except that he was belligerent and combative. His serum ETOH level was greater than 400 mg/dL. He was too combative to transport by helicopter. On arrival he complained of neck and lower back pain.

SHx/FHx: Divorced, Tobacco and ETOH abuse.

EXAM: BP 140/70 HR80 RR20 36.6C

Awake, combative, belligerent. Dysarthric speech.

CN II-XII: unremarkable.

Motor: full strength throughout, normal tone and bulk.

Sensory: no deficits to PP/Vib.

Coord: ND

Station: ND

Gait: ND

Reflexes: 2+ throughout, and plantar flexion bilaterally.

General Exam: unremarkable.

Studies:

C-spine XR series, 10/28/92: Fracture through the lateral mass of C1. There is an odontoid fracture as well which does not appear to extend into the C2 vertebral body. The odontoid fragment appears to be corticated, the chronicity of this injury is unknown. There is subluxation of the left lateral mass of C1 on C2 of 2mm. There is posterior subluxation of C1 on C2 of 3-4mm.

CT Brain and C-spine without contrast, 10/28/92: Fracture through lateral mass of C1 and disruption of the dens.

MRI C-spine, 10/30/92: Low signal intensity through the left lateral mass of C1. No evidence cord impingement or compression. Findings consistent with Jefferson fracture C1.

Course: Admitted to NSG and given MVI, Thiamine, Folate and Vit B12. He require Librium taper for delirium tremens. He was placed in a Philadelphia collar at all times. He was discharged home on 11/4/92 and returned for an O-C1-C2 fusion later.