Findings:
There is a transverse fracture of one of the limbs of the posterior ring of C1 with 1 mm diastasis but no significant displacement. There is evidence of a 2 mm anterolisthesis at the base of the dens consistent with a type 2 dens fracture. There is no dens tilting. The fracture line is difficult to discern without additional imaging. The atlanto-axial distance is normal. There is evidence of a 2 mm anterolisthesis at C4-5 and evidence of a significant (approximately 15 degrees) rotatory subluxation. This would imply a fracture of one articular pillar and likely a rotated and possibly locked facet. No distinct fracture is evident without additional CT imaging. No other abnormalities are present other than cervical trauma.

Impression:
1. There is a type-2 dens fracture. 2. There is likely a unilateral articular pillar fracture accounting for the significant rotary subluxation and 2 mm anterolisthesis at C4-C5. 3. There is a transverse posterior C1 ring fracture.

Recommendations:
For your training purposes, recommendations are not included in this report.