Cervical fracture

Cervical fracture
Classification and external resources
A fracture of the base of the dens ( a part of C2 ) as seen on CT.
ICD-10	S12
ICD-9	805.0
DiseasesDB	2322
MedlinePlus	000029
eMedicine	emerg/189

A cervical fracture is commonly called a broken neck. There are seven cervical vertebrae (neck bones) in the human neck, and the fracture of any can be catastrophic. The most common causes are traffic accidents or diving into shallow water. Abnormal movement of bones or pieces of bone can cause spinal cord injury resulting in loss of sensation, paralysis, or death.

Causes

Considerable force is needed to cause a cervical fracture. Motor vehicle collisions and falls are common causes. A severe, sudden twist to the neck or a severe blow to the head or neck area can cause a cervical fracture. Sports involving violent physical contact carry a risk of cervical fracture, including American football, ice hockey, rugby, and wrestling. Spearing an opponent in football or rugby, for instance, can cause a broken neck. Cervical fractures may be seen in several non-contact sports, such as skiing, diving, surfing, powerlifting, equestrianism, mountain biking and motor racing as Formula One Ferrari driver Gilles Villeneuve died of cervical fracture. Hanging also causes cervical fracture

Diagnosis

Severe pain will usually be present at the point of injury. Pressure on a nerve may also cause pain from the neck down the shoulders and/or arms. Bruising and swelling may be present at the back of the neck. A neurological exam will be performed to assess for spinal cord injury. X-rays will be ordered to determine the severity and location of the fracture. CT (computed tomography) scans may be ordered to assess for gross abnormalities not visible by regular X-ray. MRI (magnetic resonance imaging) tests may be ordered to provide high resolution images of soft tissue and determine whether there has been damage to the spinal cord, although such damage is usually obvious in the conscious patient because of the immediate functional consequences of numbness and paralysis in much of the body.

Treatment and after care

Complete immobilization of the head and neck should be done as early as possible and before moving the patient. Immobilization should remain in place until movement of the head and neck is proven safe. In the presence of severe head trauma, cervical fracture must be presumed until ruled out. Immobilization is imperative to minimise or prevent further spinal cord injury. The only exceptions are when there is imminent danger from an external cause, such as becoming trapped in a burning building. Non-steroidal anti-inflammatory medications (known as NSAIDs) such as aspirin, or ibuprofen are useful in decreasing swelling and pain. In the long term, physical therapy will be given to build strength in the muscles of the neck to increase stability and better protect the cervical spine.

Collars, traction and surgery can be used to immobilise and stabilize the neck after a cervical fracture. Minor fractures can be immobilized with a collar without need for traction or surgery. A soft collar is a fairly flexible and is the least limiting. It can be used for minor injuries or after healing has allowed the neck to become more stable.

A range of manufactured rigid collars are also used, usually comprising a firm plastic bi-valved shell secured with Velcro straps and removable padded liner . The most frequently prescribed are the Aspen, Malibu, Miami J, and Philadelphia collars. All these can be used with additional chest and head extension pieces to increase stability.

Rigid braces which include the head and chest, such as the SOMI, Lerman Minerva and Yale types are also prescribed. Special patients, such as very young children or non-cooperative adults, are sometimes still immobilised in medical casts, such as the Minerva cast.

Traction can be applied by free weights on a pulley or a Halo type brace. The Halo brace is the most rigid cervical brace, used when limiting motion to the minimum is essential, especially with unstable cervical fractures. It can provide stability and support during the time (typically 8-12 weeks) needed for the cervical bones to heal.

Surgery may be needed to stabilize the neck and relieve pressure on the spinal cord. A variety of surgeries are available depending on the injury. Surgery to remove a damaged intervertebral disc may be done to relieve pressure on the spinal cord. The discs are cushions between the vertabrae. After the disc is removed, the vertabrae may be fused together to provide stability. Metal plates, screws, or wires may be needed to hold vertabrae or pieces in place.

See also

• Spinal cord injury
• Cervical dislocation
• Internal decapitation
• Brown-Sequard Syndrome

References

• American Academy of Orthopaedic Surgeons, Cervical Fracture. 9/12/2006.

• Brigham And Women's Hospital Health Information - Neck Fracture. 9/12/2006.

• Cervical Fracture - DynoMed.com

• CERVICAL FRACTURE Thomson MICROMEDEX. 9/12/2006.

• Nettina, Sandra M. The Lipnincoutt Manual of Nursing Practice. Lipincott, Williams, and Wilkins. Philadelphia. 2001.

• Sama, Andrew A., MD.eMedicine - Cervical Spine Injuries in Sports. 9/12/2006

Practical Advice for Patients:

• Wearing a Halo Brace - Practical advice. 15/8/2007

• Advice for people wearing a Halo Brace. 17/5/2000

• Pamphlet containing useful information for patients wearing a Halo Brace. 15/8/2007

• University of Michigan Pamphlet containing useful information for patients wearing a Halo Brace. 15/8/2007