C1 and C2 (peg) fractures

Case contributed by Dr Ian Bickle


An elderly lady is brought to A&E with neck pain. She is believed to have fallen 'head first' down a flight of stairs.

Patient Data

Age: 85-90
Gender: Female

Fracture through the body of the odontoid peg.

Fracture of right anterior arch of C1.

Bilateral congenital non-union of the posterior arch at accessory lateral synchondroses (the bone margin here is very defined).

Multilevel degenerative change.

Case Discussion

This cervical spine trauma CT has both a peg (C2) and C1 fracture.

However, the C1 component initially was thought to be a Jefferson's fracture (we all learn everyday), however, on retrospect is only a unilateral C1 anterior arch fracture.

The linear 'defect' through the posterior arches of the atlas (C1) are smooth and rather established looking and are in fact thought to represent congenital non-union of the posterior arch lateral synchondroses.

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Case information

rID: 36618
Published: 13th Jul 2015
Last edited: 28th Apr 2017
Tag: rdgh
Inclusion in quiz mode: Included

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