![]() Stabilisation is most commonly performed via a posterior approach with the patient lying prone, the fragments then fixated using pedicle screws and rods. Unstable fractures are usually treated operatively by fusing across the injured segment of the spine to the uninjured segments above and below, with or without decompression of the vertebral canal. * If a spinal injury is identified, a further detailed examination is required the American Spinal Injury Association (ASIA) chart allows an accurate and reproducible examination to be performed Operative Management Traction devices can be used for definitive treatment when operative treatment is high risk or fraction reduction is required (e.g. Pins are placed in the outer table of the skull under local anaesthesia, and are connected to a halo device, which is mounted on a thoracic brace.Halo vests are used when more rigid support is needed, and are favoured for the non-operative treatment of unstable cervical spine fractures.Rigid collars are used for immobilisation of the cervical spine during extrication and initial assessment.Non-operative management can be appropriate for stable injuries (or may be needed for patients in whom surgical intervention is high risk): All cervical fractures need discussion with spinal specialists. Restricting movement of the spine is recommended to prevent potential damage to the spinal cord movement at the level of an unstable fracture can cause further neurological deficit*. Patients with a suspected cervical fracture must be managed as per ATLS guideline, including 3-point C-spine immobilisation, until any potential injuries have been excluded. The condition can be fatal, especially with significant displacement of the odontoid those who survive can have no neurology. Patients can present following low-impact injuries, neck pain being common. Odontoid peg fractures are common cervical fractures, most common in older patients. These fractures can be unstable in such cases, surgical fixation will be required. These are caused by cervical hyperextension and distraction (historically the forces that were delivered by a noose). 2B), usually with subluxation of the C2 vertebra on C3. These fractures are usually unstable and account for approximately a third of all C1 fractures.Ī Hangman’s fracture, also termed as traumatic spondylolisthesis of the axis, describes a fracture through the pars interarticularis of C2 bilaterally (Fig. They are often associated with head injuries and other concurrent cervical spinal injuries. ![]() It is caused by axial loading of the cervical spine resulting in the occipital condyles being driven into the lateral masses of C1. Eponymous FracturesĪ Jefferson fracture is the eponymous name given to a burst fracture of the atlas (Fig. 1B)ĭifferentials for patients presenting with cervical neck pain, with or without neurology, following injury include cervical spondylosis, cervical dislocation, or whiplash injury. Type 1 = occipital condyle and craniocervical junctionįor subaxial fractures, the AO system divides them into:.There are many classification systems to describe fractures of the cervical spine, however the AO classification is most universally used.įor upper cervical fractures (involving the C1 or C2 vertebrae), the AO system divides them into: Due to the differing shape of C1 and C2, relative to the other cervical vertebrae, they present with unique fracture patterns that vary significantly compared to conventional cervical fractures. The vertebrae of the cervical spine are frequently fractured C2 (~30%) and C7 (~20%) are the most commonly fractured vertebrae. However, it is susceptible to injury as a result, alongside having relatively small vertebral bodies. The cervical spine acts to support the head and provide mobility.
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