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.