Eli's death is a conundrum. As he fell backwards he probably had a hyperflexion injury to the cervical spine. We read that he 'broke his neck, so mere dislocation is disallowed. The Jeffersen atlas fracture is unlikely as this usually requires axial compression. Similarly the hangman's fracture of the axis generally occurs by a different mechanism extension and distraction. More likely are a unilateral or bilateral fracturedislocation, a burst fracture of the vertebral body or a fracture of the ondontoid peg.

Any of these could cause quadriplegia which with a man who was old (98) and heavy probably would result in Eli's time in an early death from pneumonia, pressure sores etc. However the text seems to to imply that he died instantly. For this to have occurred he would either have to have had a fracture above C3 so that he lost the use of his diaphragm (phrenic nerve=C3,4&5) or else a concomitant intracranial injury such as cerebral contusion or acute subdural.

Luke, preferring a single lesion which explains all, favours an odontoid peg fracture but is open to argument.