Falling fractures of the atlant: causes, symptoms, diagnosis, treatment

"Falling" fractures of the atlas, or Jepherson fractures, are rare. This can be judged at least because in the available literature there is only a description of only 5 cases of such vertebral fractures.

MN Nikitin (1965) observed 2 patients with a "bursting" atlant fracture. The author does not report the circumstances of the trauma, clinical manifestations and the method of damage in the first patient. The second patient, aged 61, was injured in a car accident. The diagnosis was made 2 weeks after the injury on the basis of radiographic data. The treatment was performed by stretching the cheekbones over the Reimers for 4 weeks, followed by wearing a cotton woolen collar. After 1.5 years, the patient independently walks, there is an upper paraparesis, with head movements in the neck, radiating to the upper limbs.

Philips in 1938 reported on a fragmentary fracture of the atlas from the loader, which occurred as a result of the fall of a cargo weighing 700 pounds to the head of the victim. In 1961, a similar fracture was reported by G-elehrter: a 13-year-old boy suffered a fracture as a result of a blow to his head against a stone during a fall. As a result of damage, there was persistent tetraparesis. Brocher (1961) described the "bursting" fracture of the Atlantean in the 53-year-old man, which arose from a fall from a motor vehicle. Damage was not accompanied by neurologic symptoms.

[1], [2], [3]

Causes of Atlant fracture

Jefferson's fracture occurs when the victim falls on his head or due to a fall on the head of the victim of considerable severity. If, at the time of violence, the head extends, a one- or two-sided fracture of the thin posterior arch of the atlant may occur as a result of its abutment in the upper edge of the more massive arc of the axis. Under the influence of violence on the head, which is in the middle position between flexion and extensionality, i.e. When violence acts vertically, the lateral masses of the atlant are compressed between the axis body and the occipital condyles, which leads to the wedging of the occipital condyles inside the Atlantic ring . This wedging is facilitated by the anatomical interposition of the articulating surfaces of the occipital condyles in the upper surfaces of the lateral masses of the atlant. Under the influence of such wedging, the front and rear arch of the atlanta burst like a dry rump, over which a blow is struck. There is a comminuted fracture of the atlant. The divergence of the bone of their fragments of the atlant in the sides protects the spinal cord from damage. This is confirmed by the fact that from the observations given in the literature only in 2 neurologic manifestations in the form of tetraparesis and tetraplegia were noted.

[4]

Symptoms of a fractured atlant

Apparently, neurological manifestations depend on the concussion of the brain, hemorrhages in the brain and surrounding tissues at the time of injury. However, the possibility of more serious brain damage is not ruled out. The danger of damage lies in the possibility of primary destruction of the medulla oblongata embedded in the axis tooth, as well as subsequent secondary damage of the elongated and upper spinal cord in case of untimely recognized fracture or careless manipulation during examination or transportation.

Clinical recognition of these lesions can meet significant difficulties due to the scarcity of symptoms and possible severe brain phenomena. Of great importance is the rarity of these injuries, as well as the lack of familiarity of practical doctors with them.

Diagnosis of atlant fracture

Decisive in diagnosis is an x-ray study. On the back spondlogram through the open mouth it is possible to determine a fracture of the posterior arch of the atlas. Fracture of the anterior arch of the atlas on the usual posterior spondylogram is not determined, since the X-ray shadow of the upper jaw and occipital bone is layered on its X-ray shadow. The front arch of the atlant can be detected on a special axial image. Therefore, an important x-ray symptom in the form of displacement of both lateral masses of the atlant outside is important. In the presence of a fracture line in the region of the posterior arc of the atlas in combination with the divergence of the atlas's lateral masses, the diagnosis of the "bursting" atlant fracture becomes valid outside.

[5]

Treatment of Atlant fracture

Treatment of "bursting" atlant fractures consists in unloading the upper cervical spine in a prolonged immobilization. This can be achieved by skeletal traction beyond the bones of the cranial vault, followed by a prolonged - up to 1 - 1.5 years - wearing a corset, or by first applying a corset, which is not always possible due to the condition of the victim. If later the instability of the upper cervical spine is revealed, operative fixation according to the type of ocipitospondylodease is shown.