Blunt neck trauma

Background

Three column concept of spinal fracture stability

• Suspect vascular damage to cord if discrepancy between neuro deficit and level of spinal column injury
• Cord injury is more likely if anterior (vertebral bodies) AND posterior (spinal canal) columns are disrupted
• Penetrating injury rarely results in unstable fracture

Fractures and Related

Vertebral fractures and dislocations types

Vertebral anatomy.

Numbering order of vertebrae.

• Cervical fractures and dislocations
  • Atlanto-occipital dissociation
  • C1
    • Jefferson fracture
    • C1 isolated anterior arch fracture
    • C1 isolated posterior arch fracture
  • C2
    • Odontoid fracture
    • Hangman's fracture
  • C3-C7
    • Cervical burst fracture
    • Cervical spinous process fracture
    • Extension cervical teardrop fracture
    • Flexion cervical teardrop fracture
    • Anterior cervical wedge fracture
  • Cervical facet dislocation
  • Isolated transverse process fracture
• Thoracic and lumbar fractures and dislocations
  • Chance fracture
  • Thoracic burst fracture
  • Lumbar burst fracture
  • Isolated transverse process fracture
  • Thoracic and lumbar compression fractures

Vascular Injuries

• Carotid and vertebral artery injuries can occur with blunt c-spine trauma
  • Half of patients present with initially normal neuro exam
  • OR for carotid/vertebral artery injury of 8.6 with c-spine fracture
  • OR for vertebral artery injury of 30.6 with transverse process fracture
  • Vertebral angiography for transverse process fractures extending into transverse foramen or evidence of vertebral-basilar insufficiency(90% show dissection or occlusion of vertebral artery)
• Indications for screening (CTA or MRA) for vascular injury
  • Unexplained neuro deficit with hyperflexion or extension injury
  • Blunt trauma to neck or seatbelt injury
  • C-spine or skull base fractures involving vascular foramina
  • Le Fort II or III facial fractures

Workup

• If find injury consider CT C-spine, x-ray rest of spine

Management

• Prehospital: see the NAEMSP National Guidelines for Spinal Immobilization

See Also

• Spinal Cord Trauma
• Spinal Cord Compression (Non-Traumatic)
• Neurogenic Shock
• C-spine (NEXUS)
• C-Spine X-Ray
• Fractures (Main)
• Unstable spine fractures‎
• C-Spine (Canadian Rule)
• Vertebral fractures

Source

• National Spinal Cord Injury Statistical Center (NSCISC). Spinal Cord Injury. Facts and Figures at a Glance. Birmingham, Ala: NSCISC; July 1996
• Ivy ME, Cohn SM. Addressing the myths of cervical spine injury management. Am J Emerg Med. Oct 1997;15(6):591-5
• Woodring JH, Lee C, Duncan V. Transverse process fractures of the cervical vertebrae: are they insignificant? J Trauma. June 1993; 34(6):797-802.
• Tintinalli's