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PEM Ortho X-ray Curriculum

General Considerations


  • Jefferson Fracture
    • Burst fracture of the ring of C1 as a result of an axial load
    • Axial force compresses the ring of C1 between the occipital condyles of the skull and the lateral masses of C2
    • Lateral offset of the lateral mass of C1 > 1 mm from the vertebral body of C2
    • See FIGURE 2
      • Note unilateral outward displacement of the right lateral mass of C1 (B arrow) 
      • There is associated increase in distance between the right lateral mass and the dens
x-ray showing a unilateral Jefferson fracture of C1
FIGURE 2: Unilateral Jefferson fracture of C1
  • Hangman's Fracture
    • Traumatic spondylolisthesis of C2
    • Occurs as a result of hyperextension, which fractures the posterior element of C2
x-ray showing a case of hangman's fracture of C2
FIGURE 3: Hangman's Fracture of C2

labeled x-ray

    • Atlantoaxial Subluxation
      • Result of movement between C1 and C2 secondary to transverse ligament rupture or a fractured dens 
      • FIGURE 4
        • Note the widened predental space and dens fracture with anterior subluxation of C1 and the dense on the remainder of the spinal column
        • Arrow indicates fracture and abnormal posterior cervical line is also shown
x-rays showing atlantoaxial subluxation
FIGURE 4: Atlantoaxial subluxation