A biomechanical study of Jefferson fractures

Fifteen specimens of the first cervical vertebra were tested by the application of pure tensile forces to failure. Seven specimens had intact transverse ligaments, and eight had transection of the transverse ligament before testing. Specimens were tested to failure by the rapid application of laterally directed tensile force to the ring; this force then was exerted through the lateral masses to simulate the mechanism of injury for this fracture as proposed by Jefferson.

To measure the biomechanical characteristics of the C1 ring, including the fracture patterns created with tensile loading, and to describe the influence of the transverse ligament on the behavior of the ring as it failed under tension.

Jefferson fractures have been reproduced in the laboratory by subjecting head and neck preparations to axial load. However, no previous detailed biomechanical studies of the fracture characteristics of the isolated C1 vertebra have been reported.

Specimens were tested to failure by rapid application of laterally directed tensile forces to the ring.

Eleven two-part and three three-part fractures occurred. The mean tensile strength of the atlas was found to be 2,280 N. The average deformation required to fracture the C1 ring was 1.57 mm. The total energy absorbed by the ring averaged 1.99 N-m. There was no statistically difference between those specimens with the transverse ligament intact and those without a transverse ligament.

The results of this study show that fractures of the C1 ring of greater than two parts can occur with pure tensile loading. The ring will fracture with as little as 1 mm of deformation.