What's the diagnosis? By Dr. Lynn Manganiello

A 75 yo male presents with neck pain after rollover MVC.  He is awake an alert, hemodynamically stable, with a normal neurological exam.  He has a hematoma over the parietal scalp and he has been immobilized in a Philadelphia cervical collar.  CT of the cervical spine is shown.  What's the diagnosis?  Scroll down for answer.



Jefferson (C1) Burst Fracture

  • unstable fracture often caused by axial load
  • majority of patients will have normal neuro exam 
  • diagnosed by cat scan cervical spine; x-ray open mouth odontoid view
  • most require rigid collar or halo brace and heal without surgical intervention
  • clinical pearls
    • 50% have additional vertebral fractures
    • evaluate with CT angiogram of the neck to assess for concomitant vascular injury


References: Nelson, M. (2019). Cervical Spine Trauma. In S. Sherman (Author), Simon's Emergency Orthopedics (8thed.). McGraw-Hill Education.