Head And Neck Injury-Biking

HISTORY: 55 year old male was bikepacking the Great Divide Mountain Bike Ride when he sustained a crash. He was found by a bystander confused with abrasions on his face with his helmet. It was unclear how long he was on the ground for. He had no memory of the accident. There was no numbness, tingling, weakness or radiation in his upper and lower extremities. He had a slight amount of neck pain. Physical Exam: Alert and oriented to person only, in no acute distress with repetitive speech. Aspen collar in place. Abrasions of his lower face, laceration of his lower lip. Non-tender to palpation of cervical spine, no step off deformities noted. Mild right sided paraspinal tenderness. Full active ROM of bilateral upper and lower extremity joints without any pain or difficulty. DIFFERENTIAL DIAGNOSIS: Strain of cervical paraspinal musclesFracture of cervical spineTraumatic brain injury TEST AND RESULTS: Head CT Negative for intracranial injury CT cervical spine wo IV contrast Minimally displaced fracture of the right lateral C1 arch/mass​​Atlantoaxial relationship on coronal reformatted images is maintainedMild discogenic degenerative changes within cervical vertebral column Final/Working Diagnosis: Jefferson fracture (fracture of C1) Treatment/Outcomes: Immobilization in Aspen Collar for 8-12 weeks Radiographs at 5 weeks and 11 weeks status post initial injury showed stable alignment without evidence of instabilityCleared to progressively return to full and unrestricted activity as tolerated at 11 weeksOnce radiographic evidence indicates stable union or stable non-union, patients can begin a gradual return to low-impact activities.During the intermediate phase between 6-12 weeks patient once the immobilization device is removed patients can start gentle ROM and strengthening exercises under a supervised exercise program Full return to high-impact sports or activities should be delayed until complete healing is confirmed, typically around 3-6 months post-injury