Spotter #xray #cspine #radiology Presentation: A Jefferson fracture is a burst fracture of C1, usually caused by a massive axial force such as diving into shallow water. X-Ray Findings: On AP peg view, the lateral masses of C1 will not align with the lateral masses of C2 and the odontoid peg will not be centered between the lateral masses of C1. On lateral view, if the transverse atlantal ligament is ruptured there can be separation of more than 3mm between the odontoid peg and the anterior arch of C1. Widening of the prevertebral soft tissue may also be present, representing hematoma around the injury. Jefferson fracture is commonly associated with other C-spine injuries and head injuries. A CT provides the best imaging of the bone, and an MRI may be required as well if there is suspicion of significant soft tissue injury. Management: If the transverse atlantal ligament is intact, conservative treatment with cervical collar immobilization is sufficient. If the ligament is ruptured the injury is unstable, and more aggressive treatments such as halo immobilization or internal fixation are required. https://www.instagram.com/p/CnZEJT9Jf35/?igshid=NGJjMDIxMWI=