Medical expert of the article
New publications
Burst fractures of the atlantus: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
"Bursting" fractures of the atlas, or Jefferson fractures, are rare. This can be judged at least by the fact that in the available literature there are descriptions of only 5 cases of such fractures of the spine.
M. N. Nikitin (1965) observed 2 patients with a "bursting" fracture of the atlas. The author does not report the circumstances of the injury, clinical manifestations, or the method of injury in the first patient. The second patient, aged 61, was injured in a car accident. The diagnosis was made 2 weeks after the injury based on radiographic data. Treatment was carried out by traction of the zygomatic bones according to Reimers for 4 weeks, followed by wearing a cotton collar of Shantz. After 1.5 years, the patient walks independently, there is upper paraparesis, pain in the neck radiating to the upper limbs when moving the head.
Philips in 1938 reported a comminuted fracture of the atlas in a loader, caused by a 700-pound load falling on the victim's head. In 1961, G-elehrter reported a similar fracture: a 13-year-old boy suffered a fracture when his head hit a rock during a fall. The injury left him with persistent tetraparesis. Brocher (1961) described a "bursting" fracture of the atlas in a 53-year-old man, caused by a fall from a car. The injury was not accompanied by neurological symptoms.
Causes of Atlas Fracture
A Jefferson fracture occurs when the victim falls on his head or when a significant weight falls on the victim's head. If the head is extended at the time of the violence, a unilateral or bilateral fracture of the thin posterior arch of the atlas may occur due to its resting on the upper edge of the more massive arch of the axis. When violence is applied to the head, which is in the middle position between flexion and extension, i.e. when the violence acts vertically, the lateral masses of the atlas are compressed between the body of the axis and the condyles of the occipital bone, which leads to the wedging of the condyles of the occipital bone into the ring of the atlas. This wedging is facilitated by the anatomical mutual arrangement of the articulating surfaces of the condyles of the occipital bone in the upper surfaces of the lateral masses of the atlas. Under the influence of such wedging, the anterior and posterior arches of the atlas burst like a dry bagel that has been struck. A comminuted fracture of the atlas occurs. The divergence of the bone from the fragments of the atlas to the sides protects the spinal cord from damage. This is confirmed by the fact that of the observations given in the literature, only 2 showed neurological manifestations in the form of tetraparesis and tetraplegia.
[ 4 ]
Symptoms of an Atlas Fracture
Apparently, neurological manifestations depend on the concussion that occurs at the time of injury, hemorrhages into the thickness of the brain and surrounding tissues. However, the possibility of more severe brain damage is not excluded. The danger of damage lies in the possibility of primary destruction of the medulla oblongata by the axis tooth that has penetrated it, as well as subsequent, secondary damage to the medulla oblongata and upper part of the spinal cord in case of an untimely recognized fracture or careless manipulations during examination or transportation.
Clinical recognition of these lesions can be difficult due to the paucity of symptoms and the potential for severe brain effects. Of no small importance is the rarity of these lesions and the lack of familiarity with them among practitioners.
Where does it hurt?
Diagnosis of atlas fracture
The X-ray examination is decisive in diagnostics. A posterior spondylogram through an open mouth can detect a fracture of the posterior arch of the atlas. A fracture of the anterior arch of the atlas is not detected on a regular posterior spondylogram, since its X-ray shadow is superimposed on the X-ray shadow of the maxilla and occipital bone. The anterior arch of the atlas can be detected on a special axial image. Therefore, the alternating X-ray symptom in the form of an outward displacement of both lateral masses of the atlas is of great importance. In the presence of a fracture line in the area of the posterior arch of the atlas in combination with an outward divergence of the lateral masses of the atlas, the diagnosis of a "bursting" fracture of the atlas becomes reliable.
[ 5 ]
What do need to examine?
How to examine?
Treatment of atlas fracture
Treatment of "bursting" fractures of the atlas consists of unloading the upper cervical spine with prolonged immobilization. This can be achieved either by skeletal traction of the cranial vault bones followed by prolonged - up to 1 - 1.5 years - wearing of a corset, or by primary application of a corset, which is not always possible due to the condition of the victim. If instability of the upper cervical spine is subsequently detected, surgical fixation by the type of occipitospondylodesis is indicated.