Intended for healthcare professionals

Endgames Picture quiz

Cervical radiography

BMJ 2009; 339 doi: (Published 15 July 2009) Cite this as: BMJ 2009;339:b2645
  1. M Bernardotto, FY2 in trauma and orthopaedics,
  2. M Butt, CT1 in trauma and orthopaedics
  1. 1Department of Trauma and Orthopaedics, Colchester General Hospital, Colchester
  1. M Bernardotto m.bernardotto{at}

    Case history

    A 46 year old white man presented to the accident and emergency department following a traffic accident. He was sitting in the passenger seat of the car and was thrown out of the vehicle upon impact. The car was travelling at 60 mph. On arrival he was conscious and initial assessment revealed only superficial lacerations on his torso and limbs. Spinal assessment showed no para-spinal muscle spasm and no localised bony or soft tissue tenderness.

    Standard radiographs of the pelvis, chest, and abdomen revealed no injury. His cervical radiograph (fig 1), however, caught the attention of the attending trauma team. No focal neurological deficit was present in the patient.


    • 1 What is the abnormality shown in the radiograph?

    • 2 What further investigations are warranted?

    • 3 When would surgery be considered?


    Short answers

    • 1 The radiograph shows aplasia of …

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