When reviewing the cervical spine using plain radiography, how far down should you be able to see?
To "clear" the neck, you need to be able to see the C7/T1 space. This case shows the importance of this as the first view highlights the C2 fracture but the potentially catastrophic C7 injury has been obscured. Using the swimmer's view (raising one arm up and one arm down as if doing a crawl) moves the shoulders and soft tissues and allows visualisation of these important structures. If the patient is unable to make this manoeuvre, CT should be considered.
There is a fracture/dislocation at the C7/T1 junction. There is a C2 pars interarticularis fracture with no significant spondylolisthesis, some asymmetric widening of the C2/3 facet joints can be seen.