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A B3 type injury is a high impact injury in a stiff spine resulting in hyperextension of the cervicothoracic junction. Most fractures are associated with severe cord injury and complete neurologic deficit. More than 50% of the fractures are associated with dural injuries and cerebrospinal fluid leak. Associated esophagus, trachea, or vertebral artery dissections at this level are common. Management is aimed at resuscitation, control of life threatening organ injuries, spinal stabilization, and rehabilitation.