The lateral c-spine x-ray shows the following features:

1. Fracture of the posterior arch of C1.
2. Fracture of the lamina of C2 (i.e. hangman’s fracture) with a disruption to the Harris Ring.
3. Widening of the anterior disc space between C2 and C3.
4. 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.