A 36 year old male was involved in a low speed motor vehicle collision where he was the restrained driver of a vehicle that was T-boned. He complained of mild cervical and thoracolumbar tenderness but denied loss of consciousness. His vital signs were stable. Physical exam found mild midline cervical and thoracolumbar tenderness without deformities.

2.  36 yo male involved in low
speed MVC. Pt was
restrained driver of car that
was T-boned. Pt c/o mild
midline cervical tenderness
and thoracolumbar
tenderness. Denies LOC.
Presents on back board w/
full c-spine precautions in
place. Denies any other
complaints.
 T 98.9 P 92 BP 132/78
O2 98% RA RR 18
 Gen: WDWN, NAD, no
obvious deformities
 HEENT: no facial TTP, no
dental pain, no contusions,
trachea midline
 Back: mild cervical midline
TTP, mild thoracolumbar
TTP, no step-offs, no bony
deformities

3. “Bowtie sign”
© 2000 by the Rector & Visitors of the University of Virginia
http://www.med-ed.virginia.edu/courses/rad/cspine/
http://radiopaedia.org/articles/facet-dislocation

4.  Description
 Facet joint dislocation and rupture
of the apophyseal joint ligaments
resulting from rotatory injury of
the cervical vertebrae.
 Mechanism
 Simultaneous flexion and rotation
 Radiographic features: lateral or
oblique views
 Anterior dislocation of affected
vertebral body by less than half of
the vertebral body AP diameter.
 Discordant rotation above and
below involved level.
 Widening of the disk space.
 "Bow tie" or "bat wing" appearance
of the overriding locked facets.
 Stability: stable
© 2000 by the Rector & Visitors of the University of Virginia
http://www.med-ed.virginia.edu/courses/rad/cspine

5.  Maintain C-spine
precautions
 Consult Spine
 Various mgmt strategies
 Closed reduction w/
axial traction
 Open reduction w/
posterior fixation
 Obtain prereduction CT
or MRI
http://radiopaedia.org/articles/facet-dislocation

6.  4 radiographic signs of unilateral facet dislocation
Double-diamond or “Bow tie”
2. Narrowing of the laminar space
3. Anterior slippage of the vertebral body
4. Widening of the spaces between vertebral bodies
“fanning”
1.

7. “Bowtie sign”
http://radiopaedia.org/articles/facet-dislocation