Odontoid fracture type II and Jefferson fracture

Case contributed by Dr Yair Glick

Presentation

Fell and hit his face hard. "Raccoon eyes".

Patient Data

Age: 75 years
Gender: Male

Tip of nose not included in scan because radiographer did not center the head properly.
Nonetheless, nondisplaced right nasal fracture seen with accompanying left maxillary hemosinus.
Anderson-D'Alonzo type II odontoid fracture.
C1 fractured on both sides of the posterior arch.
Left periorbital hematoma.

Prominent CSF spaces.
Widespread leukoaraiosis. Numerous bilateral lacunar infarcts in the basal ganglia and thalami.
Parasagittal pontine lacunar infarct.
Calcified cavernous carotids and carotid bifurcations.

Case Discussion

Fell at home and hit his head. Presented to the ER with "racoon eyes".
Besides a nasal fracture, sustained an Anderson-D'Alonzo type II odontoid fracture and a Jefferson fracture of the posterior arch of C1, the mechanism presumably being neck hyperextension due to impact of his face. Of note, there is no soft tissue swelling nor is there hematoma around the fractures. This is probably because a fairly light blow was enough to cause his neck fractures, as he has osteoporosis (formally diagnosed). The neck fractures were unexpected, which is why he only had a CT head. Subsequently underwent CT neck (not shown), which revealed ankylosis of C4-C5-C6 but no additional fracture.

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