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”.

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.


  1. I feel your sweat…

  2. My husband, severely disabled from polio, has 2 curves in his back from scoliosis, and a kyphosis in the neck, with displaced spinal cord at c5 c6. He also has SEVERE muscle atrophy weighing a grand total of 95 lbs. When it became apparent the scoliosis was worsening, our doctor sent us looking for help to see if there was something to do to stop the progression.

    Every doctor we went to would look at his MRI, examine him, but none asked him to walk, about the third time, it started to become funny as we realized, they weren’t asking him to walk because they were assuming he could not walk. The 5th doctor was hilarious, and funny and a bit of a smart elic, which brought out the smartelic in myself.
    When it came time to leave, after apologizing for not being able to help, he said “Ok, where’s the wheelchair” I started to laugh and said “He walks”
    The doctor laughed and said “No, really, where’s the chair”
    Don laughed “I can walk”
    The doctor by now was really looking for his wheelchair … laughing … and Don stood up from the table and started to walk … the doctor stumbled and about fell over and said “um, I need to finish the exam and um, check your gait.”

  3. Have you tried osteopathic medicine?

  4. Our PCP is a D.O. so were a couple of (but not all) of the specialists we went to.

    He’s beyond osteopathic, or surgical repair, or bracing …or .. or … or …

    If you go to my web page, there are pictures of him laying down with kittens on his chest, you can see kind of what his curve is like, but his clothes hide it well.

  5. A case like this makes you wonder what your ER’s standing orders should be for every patient who walks through your doors c/o neck pain after an injury. This patient could have walked into any ER anywhere with the same lesion.


  1. GruntDoc: Ground Level Fall and the C2 fracture

    Big Al has a post with images of one of the most horrific injuries you can imagine – a fracture of the second cervical vertebra , caused by a ground level fall.