The lateral c-spine x-ray shows the following features:
- Fracture of the posterior arch of C1.
- Fracture of the lamina of C2 (i.e. hangman’s fracture) with a disruption to the Harris Ring.
- Widening of the anterior disc space between C2 and C3.
- Widening of the soft tissue space anterior to the C1 and C2 vertebra.
Harris Ring is a normal anatomical structure seen on a lateral c-spine x-ray. It is a ring-like density seen over the central part of the body of C2 and is a confluence of radiographic shadows. This ring is disrupted in fractures involving the body/lamina of C2.
This is a highly unstable cervical spine injury and as such, neck immobilisation was continued and immediate orthopaedic referral was sought.
Reference: Grainger and Allison’s Diagnostic Radiology, A Textbook of Medical Imaging, 6th edition.