IS Case 324: Fracture dislocation at C6-7 with distraction

A. R. Klekers, MD

Imaging Sciences URMC 2009
Publication Date: 2009-09-14

History

Patient is a 54-year-old female unresponsive after being hit by car.

Findings

AP and lateral views of the cervical spine demonstrate intact spine to C6 with complete fracture and dislocation at C6-7 with distraction.

Diagnosis

Fracture dislocation at C6-7 with distraction

Discussion

For proper radiographic evaluation of the cervical spine the patient should remain immobilized at the neck. Three views should be included which are a true lateral view including C1 to C7-T1 junction, AP view, and open mouth odontoid view. If true lateral does not cover the spine to the T1 level a swimmer's view should be obtained. If the additional view does not cover to T1 then the patient should remain immobilized and computed tomography should be performed. Some missed fractures, subluxations, and dislocations are secondary to misinterpretation. Most overlooked cervical spine injuries are secondary to suboptimal film series not including the appropriate levels. This case is a good example of how an inadequate lateral view of the cervical spine does not demonstrate a severe injury appropriately.

References

Graber MA, Kathol M. Cervical spine radiographs in the trauma patient. Am Fam Physician. 1999 Jan 15;59(2):331-42. PMID: 9930127