James Platt White, MD (1811-1881), one of the founders and leading figures of the Buffalo Medical College and a pioneer in American obstetrics and gynecology, suffered an interesting and remarkable accident to his neck at the age of 26 while traveling in a stagecoach in Western New York. He was confined to bed until after 45 days, a piece of bone was discharged into his pharynx and then expectorated. The segment of bone proved to be the anterior arch of his atlas (C1) vertebra. He recovered completely from this injury except for permanent loss of rotation of his head and neck. However, he was without functional disability until his death, 44 years later, at the age of 70. This case documents the clinical result during a 44-year period after traumatic loss of the anterior arch of C1. Such cases have been reported only rarely in the literature. Only limited information is available regarding the long-term clinical significance of a Jefferson fracture with exfoliation of the anterior arch of C1. My analysis suggests that White suffered an open Jefferson's fracture that became infected. The anterior arch of C1 became a sequestrum and was discharged spontaneously into his pharynx and then expectorated. This case report with decades of followup should be of interest to all who care for patients with cervical spine injuries and those who are interested in the history of medicine in Western New York.
From the Department of Orthopaedic Surgery, State University of New York at Buffalo, Buffalo, NY.
The author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Correspondence to: Eugene R. Mindell, MD, Department of Orthopaedic Surgery, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo General Hospital, Ste. B280, 100 High Street, Buffalo, NY 14203. Phone: 716-859-1531; Fax: 716-859-2541; E-mail: email@example.com.