A 42 years old male was hit on his head and neck by a heavy-weight on January 2, 2007. When he was injured, there was an about 8cm wound and bleeding in the top of scalp with multiple bruise over the trunk and limbs. There was about half an hour lose of consciousness after the injury. After regaining consciousness, he could remember how he was injured. No swirling in head, no nausea, no vomiting, no haemoptysis, no difficulty in breath, no abdomen pain, and the bowel and bladder function were normal, but he felt head and neck pain, and can not move his head, neck, and limbs actively. The right limbs are more severe than the left. After debridement and suture of the scalp wound in a local hospital, he was forwarded to our hospital on January 4, 2007.

Physical examination:

He was sent to our Department with a stretcher. His neck was fixed with a collar, The wound on the top of the scalp has been debrided and sutured. There was tenderness around his neck, No obvious deformities were observed in spine including cervical, throracic, and lumbar spine. He can move his left upper limb and lower limb freely and actively. The sensation over his limbs and body was normal. Muscle strength: Deltoideus: Left/Right=IV/III, Biceps brachial: Left/Right=IV/III, Triceps brachial: Left/Right=IV/II, Flexor carpi radialis: Left/Right=IV/I, Extensor carpi radialis: Left/Right=IV/I, Flexor digitorum: Left/Right=IV/0, Extensor digitorum: Left/Right=IV/0, Extensor policis longus: Left/Right=IV/0, Iliopsoas: Left/Right/=IV/III, Femoral Abductors: Left/Right=IV/III, Femoral Adductors: Left/Right=IV/III, Femoral quadriceps: Left/Right=IV/III, Knee flexors (including femoral biceps, semimembranosus muscle and semitendinosus muscle, I do not know the exact name of this group of muscles) : Left/Right=IV/III, Tibialis anterior: Left/Right=IV/III, Extensor hallucis longus: Left/Right=IV/III, Extensor digitorum in foot: Left/Right=IV/III, Peroneus longus and brevis: Left/Right=IV/III, Triceps surae: Left/Right=IV/III, Tibialis posterior: Left/Right=IV/III, Flexor digitorum in foot: Left/Right=IV/III. Abdominal reflex is normal, cremasteric reflex is normal. Bilateral brachial biceps and triceps jerks are normal. Bilateral knee jerk and Achillis jerk are over active. Hypermyotonia was not observed in limbs. No patellar clonus and ankle clonus. The bilateral Hoffmann sign, Babinski sign, Chaddock sign, Oppenheim sign and Gordon sign were negative.

After hospitalization, the skull traction was applied with antibiotics, anti-edema agents, the muscle strength in right upper limb is recovered to grade II-IV, the muscle strength in right lower limbs are to grade IV. The sensation is normal.

Diagnosis: C1 Jefferson Fracture with Hangman fracture of C2.

After the hospitalization, there are three surgical plan come into our mind, The one is to perform a occipitocervical fusion and instrmentation via posterior approach. The second is to use the pedicle screw instrumentation and fusion of C1-2. The third is to use Halo-vest to fix the fracture in-situ and let them to heal. I do not know whether the Halo-vest can give us a successful fracture healing result, especially for the C1 fracture which as a large separation between the two fractured fragment of C1.

Your suggestions are appreciated very much.

Below are the images of this case.