In September 2022, the *Journal of Orthopaedic Case Reports* published a tragic case involving an 18-year-old male worker in India who suffered a fatal cervical spine injury after a heavy metallic object fell directly on his head. The impact caused a rare retropulsion fracture of the C5 vertebral body, along with a fracture of the postero‑superior portion of C6. Despite emergency stabilization, the young man died two days later. This injury pattern is unprecedented, defying standard classification systems like Allen & Ferguson, SLICS, and AO Spine.
The accident occurred suddenly at the workplace. The object struck the frontal region of his head, causing immediate loss of consciousness, respiratory distress, and shock. Emergency responders performed rapid intubation, applied a rigid cervical collar, and transported him to the hospital. Non-contrast CT imaging revealed the C5 vertebral body was crushed backward into the spinal canal—a “nutcracker-like” axial flexion-compression injury—without displacement of facets or pedicles.
Despite cervical traction, ventilation support, and rapid stabilization, the severity of canal compromise and hemodynamic instability rendered surgical intervention impossible, and the patient passed within 48 hours.
Medically, this case highlights how a single falling object, even from modest height, can produce catastrophic cervical spine injuries. It also exposes limitations in current injury classification systems, emphasizing the need for broader frameworks that include atypical patterns.
From a safety perspective, the case underscores strict workplace precautions: wearing certified helmets, avoiding standing beneath suspended loads, and securing heavy objects overhead. Prompt, careful immobilization and rapid imaging are essential for suspected neck injuries.
Ultimately, this case serves as a stark reminder of the devastating consequences of axial trauma to the cervical spine and the critical importance of prevention, occupational safety, and awareness of rare injury patterns in clinical practice.
