Unilateral Rotary Subluxation of C-3 on C-4

Otto E. Aufranc, MD; William N. Jones, MD; William H. Harris, MD
JAMA. 1963;185(13):1031-1035. doi:10.1001/jama.1963.03060130049013.
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Dr. Maureen Molloy: An 18-year-old healthy man fell headfirst a distance of about 12 ft into 2 ft of water. He was uncertain whether or not he lost consciousness, but from the time of the accident he was unable to move his right arm well. He was taken to a neighboring hospital where x-ray films showed a "dislocation of C-3 on C-4." An adjustable cervical collar was applied, and he was referred to the Massachusetts General Hospital for treatment.

On arrival in the emergency ward, approximately 8 hours after the injury, he was drowsy but could be aroused easily. His blood pressure was 130/80 mm Hg, his pulse 88 beats per minute, and his respirations 18 per minute. There was blood on both lips with a laceration of the midupper gum. His nostrils were crusted with blood.

The patient's chest was clear to percussion and auscultation. Both the diaphragm and intercostal


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