A 61 yo F presents to the ED with neck pain after a fall down 15 steps. She denies numbness, weakness or paresthesias in her extremities and has normal strength and sensation on exam. She does have midline tenderness of her cervical spine. A CT of the cervical spine is done and shown below. What's the diagnosis? (scroll down for answer) 

Answer: Anterior arch of C1 fracture and base of C2 fracture 

• C1 fractures
• Isolated anterior arch fractures- in isolation, not unstable, consider operative intervention
• Jefferson fracture
• burst fracture of the atlas -- fractures of the anterior and posterior arches of C1 (with or without disruption of the transverse ligament) 
• Posterior neural arch fracture of C1
• caused by hyperextension--> compresses posterior elements between occiput and spinous process of C2
• C2 fractures
• Isolated body fractures- in isolation, not unstable 
• Odontoid Process (dens) fractures
• Type I- throught the tip of the dens -stable
• Type II- fracture at the base of the dens - unstable
• Type III- fracture at the junction of the odontoid and C2 (through lateral masses)-  unstable 
• Hangman's fracture 
• traumatic spondylolisthesis of the axis (bilateral pars interarticularis fracture)
• typically due to extreme hyperextension secondary to abrupt deceleration
• Remember your unstable C-spine fractures! (Jefferson Bit Off A Hangman's Thumb & Pinky)
• Jefferson burst fracture (burst fracture of the atlas of C1)
• Bilateral facet fracture
• Odontoid process fractures (types II and III)
• Any fracture with dislocation
• Hangman's fracture
• Teardrop fracture (fracture of the anterior inferior aspect of cervical vertebral body)
• Posterior neural arch of C1