Presentation
Fall down stairs while playing. Neck pain and restriction of movement.
Patient Data
3-view cervical spine x-ray. The AP does not include the craniocervical junction and the peg is oblique.
On the lateral view, the vertebral bodies below C6 are not visualized (superior aspect of C7 just seen). The atlantodental interval is normal (less than 3.5 mm).
Repeat lateral and peg views. Normal alignment on the lateral with no prevertebral soft-tissue swelling.
Midline fracture of the arch of C1 on the peg view.
Displaced 2-part fracture of C1 with a posterior midline defect and anterior fracture through the ring to the left of midline. The lateral masses of C1 are falling off the body of C2.
Case Discussion
Suboptimal views failed to identify the C1 fracture. Repeat views confirmed a C1 fracture that was further investigated with limited CT. This confirmed a 2-part Jefferson fracture.
Transfer to regional neurosurgical center with Halo-fixation.
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