Presentation
Fall from standing height. Tender C spine.
Patient Data
Age: 80 years
Gender: Male
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Fracture through the base of the odontoid process of C2 with 3 mm of posterior displacement of the odontoid process. Both the lateral masses of C1 are intact but posterior subluxed with respect to C2.
There is focal hyperdensity in the vertebral canal posterior to the C1-2 articulation which likely represents spinal epidural hematoma. No displacement of the spinal cord.
No further cervical spine fracture. Extensive degenerative changes.
Impression
- Transverse fracture through the base of the odontoid process of C2 (type 2) with 3 mm of posterior displacement of the odontoid process.
- The lateral masses of C1 are posteriorly subluxed with respect to C2.
- Focal hyperdensity posterior to the C1-C2 articulation represents epidural hematoma. C1-2 ligamentous injury is suspected.
Case Discussion
The peg injury represents a type 2 Anderson and D'Alonzo fracture. As it is transversely oriented, it is classified as a Roy-Camille type 3 injury.
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