The patient came to the emergency of the Shmaisani hospital from Saudi Arabia 14-March-2013 after suffering RTA the night of 13-March-2013 without loss of consciousness but after that got severe neck pain and inability to move it with severe pain in the left shoulder with numbness of the left side of the neck. CT-scan of the brain and neck done the same day of bad quality and unreadable.

X-ray of the cervical spine showed dislocation of C2-3 with chip of bones in the left C2-3 lateral mass. X-ray of the left shoulder is normal. CT-scan of the neck repeated with thin cuts and 3-D reconstruction confirming the dislocation and complete destruction of the left L2-3 lateral mass. MRI cervical spine done 15-March-2013 showing slight malacia of the spinal cord at the fractured level, but the vertebral artery is in relatively acceptable condition.

On examination: The patient with hard neck collar with paresis of the left upper and lower limbs with analgesia of the left side of the neck. The patient claiming that he has severe fainting when raising his head.

Considering that there is no disc extrusion, using C-arm the C2-3 level was identified and using Zimmer cervical plate one level 24 mm length with 2 variable screws 14x4.2 mm inserted to C2. One variable screw 14x4.6 mm inserted to the right side of C3  and 16x4.2 mm to the left side of C3. All stages of surgery were done using C-arm control.

Routine closure of the wound. Smooth postoperative recovery. The power of the left side became normal.

The patient had unstable fracture of C2-3 with complete destruction of the left C2-3 lateral mass. To preserve the left vertebral artery and avoid further deterioration of the spinal cord, internal fixation is the only available best option.