Ground Level Fall and the C2 fracture

At work recently, I got one of those really interesting phone calls:
PMD:”I’ve just sent a patient of mine to your ER. Fell a few days ago, came in today, and I got a CT.”
Me:”OK, what’s the CT show?”
PMD:”Got a C2 fracture with a 1.2cm subluxation.”
Me:”Uhh…call EMS, have patient put in a c-collar, secured to a backboard with head sandbagged, and we’ll be glad to see them.”
PMD:”Oh, they’ve already left, pt’s daughter is driving them over”.
Me:”….okay….”

The patient arrived, completely neurologically intact, thank heavens. A more pleasant patient and family could not be had, and this nice patient had probably had this fracture for several days, from the history!

Film on the left, normal alignment diagram on the right:

And patient's alive, walks and talksnormal alignment
Click for larger images

If you showed me this CT and asked me to guess the patients’ neurologic status, I’d guess high-quad at best, but patient was completely intact! Admitted to neurosurgery. Ground level falls can and do cause c-spine fractures. This is the scariest one I’ve seen with a good outcome.