This JAAOS review covers the full spectrum of upper cervical spine trauma — from occipital condyle fractures to hangman's fractures — with a focus on classification systems, radiographic diagnosis, and treatment algorithms. The central question: given that these injuries are often occult and potentially fatal, how do you accurately diagnose and manage each injury type based on anatomic location and ligamentous stability?
When you see a high-energy polytrauma patient with any craniocervical injury, apply Harris lines immediately — a BDI or BAI >12 mm demands CCD workup, and a normal-appearing CT does not exclude it.
If MRI shows ligamentous injury but alignment looks maintained, provocative traction fluoroscopy under expert supervision distinguishes the deceptively stable-appearing but surgically urgent Harborview stage 2 CCD from a truly stable stage 1 injury.
This JAAOS review covers the full spectrum of upper cervical spine trauma — from occipital condyle fractures to hangman's fractures — with a focus on classification systems, radiographic diagnosis, and treatment algorithms. The central question: given that these injuries are often occult and potentially fatal, how do you accurately diagnose and manage each injury type based on anatomic location and ligamentous stability?
When you see a high-energy polytrauma patient with any craniocervical injury, apply Harris lines immediately — a BDI or BAI >12 mm demands CCD workup, and a normal-appearing CT does not exclude it.
If MRI shows ligamentous injury but alignment looks maintained, provocative traction fluoroscopy under expert supervision distinguishes the deceptively stable-appearing but surgically urgent Harborview stage 2 CCD from a truly stable stage 1 injury.