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Anatomy

Head and Neck

Question 98 of 180

A 28 year old male was brought into ED by the police following a drunken brawl. He has been punched on his mandible, resulting in subluxation of the atlanto-axial joint. Which of the following movements is most likely to be affected by this movement:

Answer:

The atlanto-axial joints allow the head to rotate from side to side.

Atlas

Vertebra C1 (the atlas) is distinguished by its lack of vertebral body, essentially being composed of two lateral masses interconnected by an anterior and posterior arch. Each lateral mass articulates above with an occipital condyle of the skull and below with the superior articular facet of vertebra C2 (the axis). The posterior surface of the anterior arch has an articular facet for the dens of the axis.

The atlanto-occipital joints allow the head to nod up and down on the vertebral column.

Axis

The axis is characterised by the large dens, which extends superiorly from its vertebral body to articulate with the anterior arch of the atlas, and by its bifid spinous process. The dens is held in position by the strong transverse ligament of atlas posterior to it and spanning the distance between the lateral masses of the atlas.

The atlanto-axial joints allow the head to rotate from side to side.

By OpenStax College [CC BY 3.0], via Wikimedia Commons

Structure of the Cervical Vertebrae. (Image by OpenStax College [CC BY 3.0], via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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