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. 1997 Apr-Jun;32(2):159–162.

Fracture of the First Cervical Vertebra in a High School Football Player: A Case Report

Tim P Trupiano 1,2,3, Michelle L Sampson 1,2,3, Marc W Weise 1,2,3
PMCID: PMC1319821  PMID: 16558448

Abstract

Objective:

To present the case of a high school football player with a burst fracture of the ring of C1 resulting from a “spearing” tackle.

Background:

Cervical spine fractures are rare in collision sports, but their potentially grave consequences mean that they must be given special attention. Spearing was banned by the National Collegiate Athletic Association and the National Federation of High School Athletic Associations in 1976, and the number of cervical spine fractures in high school and college football players has fallen dramatically. However, cervical spine fractures do still occur, and they present a diagnostic challenge to sports medicine professionals.

Differential Diagnosis:

Cervical sprain.

Treatment:

Treatment consists of halo-vest immobilization. Surgical fusion may be necessary for unstable C1-C2 fractures, although initial halo-vest treatment is usually attempted.

Uniqueness:

A 17-year-old defensive back attempted to make a tackle with his head lowered. He was struck on the superolateral aspect of the helmet by the opposing running back. He remained in the game for another play, but then left the field under his own power, complaining of neck stiffness and headache. Physical examination revealed upper trapezius and occiput tenderness, bilateral cervical muscle spasm, and pain at all extremes of voluntary cervical movement. He was alert and oriented, with a normal neurologic examination. Treatment with ice was attempted but was discontinued due to increased pain and stiffness. Heat resulted in decreased pain and stiffness, but his symptoms persisted, and he was trans- ported to the emergency room. Plain radiographs were read as negative, but a CT scan demonstrated a burst fracture of Cl. He was treated with halo-vest immobilization for 8 weeks and a rigid cervical collar for 8 additional weeks. Physical therapy was then initiated, and normal cervical range of motion and strength were restored within 6 weeks. The athlete competed in track 6 months after the injury and continues to play recreational sports without difficulty. At clinical follow-up 8 months after injury, he had full, painless cervical range of motion and a normal neurologic examination.

Conclusions:

A potentially devastating cervical spine injury can present insidiously, without dramatic signs or symptoms. Therefore, sports medicine professionals must retain a high index of suspicion when evaluating athletes with cervical spine complaints.

Keywords: Jefferson fracture, C1, atlas, athletic injury

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bailes J. E., Hadley M. N., Quigley M. R., Sonntag V. K., Cerullo L. J. Management of athletic injuries of the cervical spine and spinal cord. Neurosurgery. 1991 Oct;29(4):491–497. doi: 10.1097/00006123-199110000-00001. [DOI] [PubMed] [Google Scholar]
  2. Biasca N., Simmen H. P., Bartolozzi A. R., Trentz O. Review of typical ice hockey injuries. Survey of the North American NHL and Hockey Canada versus European leagues. Unfallchirurg. 1995 May;98(5):283–288. [PubMed] [Google Scholar]
  3. Cantu R. C., Mueller F. O. Catastrophic spine injuries in football (1977-1989). J Spinal Disord. 1990 Sep;3(3):227–231. [PubMed] [Google Scholar]
  4. Greenan T. J. Diagnostic imaging of sports-related spinal disorders. Clin Sports Med. 1993 Jul;12(3):487–505. [PubMed] [Google Scholar]
  5. Han S. Y., Witten D. M., Mussleman J. P. Jefferson fracture of the atlas. Report of six cases. J Neurosurg. 1976 Mar;44(3):368–371. doi: 10.3171/jns.1976.44.3.0368. [DOI] [PubMed] [Google Scholar]
  6. Kesterson L., Benzel E., Orrison W., Coleman J. Evaluation and treatment of atlas burst fractures (Jefferson fractures). J Neurosurg. 1991 Aug;75(2):213–220. doi: 10.3171/jns.1991.75.2.0213. [DOI] [PubMed] [Google Scholar]
  7. Lehman L. B. Preventing and anticipating neurologic injuries in sports. Am Fam Physician. 1988 Oct;38(4):181–184. [PubMed] [Google Scholar]
  8. Levine A. M., Edwards C. C. Treatment of injuries in the C1-C2 complex. Orthop Clin North Am. 1986 Jan;17(1):31–44. [PubMed] [Google Scholar]
  9. Noguchi T. A survey of spinal cord injuries resulting from sport. Paraplegia. 1994 Mar;32(3):170–173. doi: 10.1038/sc.1994.30. [DOI] [PubMed] [Google Scholar]
  10. Segal L. S., Grimm J. O., Stauffer E. S. Non-union of fractures of the atlas. J Bone Joint Surg Am. 1987 Dec;69(9):1423–1434. [PubMed] [Google Scholar]
  11. Silver J. R., Gill S. Injuries of the spine sustained during rugby. Sports Med. 1988 May;5(5):328–334. doi: 10.2165/00007256-198805050-00005. [DOI] [PubMed] [Google Scholar]
  12. Spence K. F., Jr, Decker S., Sell K. W. Bursting atlantal fracture associated with rupture of the transverse ligament. J Bone Joint Surg Am. 1970 Apr;52(3):543–549. [PubMed] [Google Scholar]
  13. Torg J. S. Trampoline-induced quadriplegia. Clin Sports Med. 1987 Jan;6(1):73–85. [PubMed] [Google Scholar]
  14. Torg J. S., Vegso J. J., O'Neill M. J., Sennett B. The epidemiologic, pathologic, biomechanical, and cinematographic analysis of football-induced cervical spine trauma. Am J Sports Med. 1990 Jan-Feb;18(1):50–57. doi: 10.1177/036354659001800109. [DOI] [PubMed] [Google Scholar]
  15. Torg J. S., Vegso J. J., Sennett B., Das M. The National Football Head and Neck Injury Registry. 14-year report on cervical quadriplegia, 1971 through 1984. JAMA. 1985 Dec 27;254(24):3439–3443. [PubMed] [Google Scholar]

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