Differential diagnosis of pediatric cervical spine fractures

• Atlanto axial rotatory subluxation
• C1 fracture (Jefferson fracture)
• C2 fracture (Hangman fracture)
• C7 spinous process fracture (Clay shoveler fracture)
• C3-C7 vertebral body fracture
• Facet fracture
• Fracture dislocation with perched facets
• Hematoma without fracture

Approach to the differential diagnosis of cervical spine fractures:

• Make sure you can see C7-T1
• Check cevical-basilar alignment / relationships
• Check prevertebral soft tissues for hematoma
• Check open mouth odontoid / coronal view for atlanto axial rotatory subluxation and C1 / Jefferson fx
• Check alignment of cervical spine by checking 4 lines going through:
  — Anterior part of vertebral bodies
  — Posterior part of vertebral bodies = anterior border of spinal canal
  — Posterior border of spinal canal
  — Posterior border of spinous processes
• Check alignment of articular facets and neuro foramina
• Check sinuses for air fluid levels and other skull structures for fractures