Physical Examination

Neurologic assessment of C2 (axis) fractures (C2 nerve root) includes the following:

Motor - Muscles that have a contribution from the C2 nerve root include the sternocleidomastoid (SCM), trapezius, longus capitis, longus colli, rectus capitis anterior, splenius capitis, splenius cervicis, and semispinalis capitis
Sensory - The C2 nerve root provides sensory innervation to the posterior scalp, anterolateral neck, and anteroinferior and posteroinferior external ear
Reflexes - The SCM reflex, which may be elicited by tapping on the clavicular end of the muscle

Clinical examination includes the following:

Observe and palpate for deformities and step-offs
Test muscle strength and tone of upper and lower extremities
Perform sensory testing on upper and lower extremities
Perform rectal examination
Test trapezius muscles by asking patient to shrug shoulders
Observe for torticollis

Workup

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Media Gallery

Odontoid type II fracture
Atlantooccipital and atlantoaxial dissociation
Hangman fracture
Three types of C2 odontoid fractures: type I is an oblique fracture through the upper part of the odontoid process; type II is a fracture occurring at the base of the odontoid as it attaches to the body of C2; type III occurs when the fracture line extends through the body of the axis.

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Author

Igor Boyarsky, DO, FACEP, FAAEM Emergency Room Physician, Kaiser Permanente Southern California

Igor Boyarsky, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Anti-Aging Medicine, American Academy of Emergency Medicine, American College of Emergency Physicians, American Osteopathic Association

Disclosure: Nothing to disclose.

Coauthor(s)

Gary Godorov, MD Staff Physician, Department of Emergency Medicine, Bellflower Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

William O Shaffer, MD Orthopedic Spine Surgeon, Northwest Iowa Bone, Joint, and Sports Surgeons

William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Kentucky Medical Association, North American Spine Society, Kentucky Orthopaedic Society, International Society for the Study of the Lumbar Spine, Southern Medical Association, Southern Orthopaedic Association

Disclosure: Received royalty from DePuySpine 1997-2007 (not presently) for consulting; Received grant/research funds from DePuySpine 2002-2007 (closed) for sacropelvic instrumentation biomechanical study; Received grant/research funds from DePuyBiologics 2005-2008 (closed) for healos study just closed; Received consulting fee from DePuySpine 2009 for design of offset modification of expedium.

Chief Editor

Jeffrey A Goldstein, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Director of Spine Service, Director of Spine Fellowship, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center

Jeffrey A Goldstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, AOSpine, Cervical Spine Research Society, International Society for the Advancement of Spine Surgery, International Society for the Study of the Lumbar Spine, Lumbar Spine Research Society, North American Spine Society, Scoliosis Research Society, Society of Lateral Access Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Medtronic, Nuvasive, NLT Spine, RTI, Magellan Health<br/>Received consulting fee from Medtronic for consulting; Received consulting fee from NuVasive for consulting; Received royalty from Nuvasive for consulting; Received consulting fee from K2M for consulting; Received ownership interest from NuVasive for none.

Additional Contributors

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) Professor, Department of Orthopedic Surgery, University of Texas Medical School at Houston

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

C2 (Axis) Fractures Clinical Presentation

Physical Examination

References

Tables

Contributor Information and Disclosures

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