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1. Type II odontoid fracture

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Figure 25-1

Type II odontoid fracture.

This 4-year-old child suffered a hyperflexion injury when he was struck in the head by a truck tailgate. A. A lateral radiograph shows anterior displacement of the odontoid process and widening of the synchondrosis. The C2 spinous process projects posterior to the posterior cervical line due to anterior displacement of C1. There is prevertebral soft tissue prominence (arrows). B. A sagittal CT image confirms a fracture through the synchondrosis of the odontoid. There are small fracture fragments adjacent the base of the displaced odontoid.

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2. Atlantooccipital dislocation

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Figure 25-2

Atlantooccipital dislocation.

A lateral radiograph of a teenager involved in a motor vehicle crash shows marked distraction of C1 from the skull. There is also atlantoaxial separation. Marked retropharyngeal soft tissue prominence is present.

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3. Type II odontoid fracture

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Figure 25-3

Type II odontoid fracture.

A. There is no visible fracture or vertebral malalignment on the lateral view obtained in neutral position. Marked prevertebral soft tissue prominence suggests a significant injury, however. B. A spot film image obtained during neck flexion shows anterior tilting of the odontoid and malalignment between the neural arches of C1 and C2.

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4. Bilateral neural arch fractures of the axis

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Figure 25-4

Bilateral neural arch fractures of the axis.

This child suffered a severe hyperextension injury during a motor vehicle crash. CT shows nondisplaced neural arch fractures (arrows).

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5. Neural arch fractures of C2

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Figure 25-5

Neural arch fractures of C2.

A lateral radiograph of a child involved in a motor vehicle collision demonstrates bilateral C2 pars interarticularis fractures. There is traumatic spondylolisthesis, with anterior displacement of C1 and the body of C2 relative to the remainder of the cervical spine.

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6. Atlantoaxial rotatory fixation; Fielding type I

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Figure 25-6

Atlantoaxial rotatory fixation; Fielding type I.

A. A CT scout image of a 15-year-old boy with torticollis shows rotation of the head to the left. B. An axial CT at the level of the atlas shows approximiately 35° rotation of the head and the atlas relative to the tabletop. There is no separation between the odontoid and the anterior aspect of C1. C. A more inferior image shows C2 to be in neutral position.

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