NECK (CERVICAL SPINE) FRACTURE |
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General Information
DEFINITION--A complete or incomplete break in a bone in the neck (cervical spine). Injuries to this region of the spine are frequently a combination of sprain, dislocation and fracture. The most serious can injure the spinal cord, leading to paralysis or death.
BODY PARTS INVOLVED
Bones in the neck (cervical spine).
Joints in the cervical spine.
Spinal cord (sometimes).
Soft tissue surrounding the fracture site, including muscles, nerves, tendons, ligaments, periosteum (covering to bone), blood vessels and connective tissue.
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SIGNS & SYMPTOMS
Severe pain in the neck at the fracture site.
Swelling of soft tissue around the fracture.
Tenderness to touch.
Numbness below the fracture site (sometimes).
CAUSESDirect blow or indirect stress to the neck. Indirect stress may be caused by twisting.
RISK INCREASES WITH
Diving.
Gymnastics (tumbling or trampoline activities).
Contact sports, particularly football.
History of bone or joint disease, especially osteoporosis.
Obesity.
Poor nutrition, especially insufficient calcium.
If surgery or anesthesia is necessary, surgical risk increases with smoking and use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENT
Build your strength with a good conditioning program before beginning regular athletic practice or competition. Increased muscle mass provides additional protection to your bones.
Use a "spotter" (helper) when attempting difficult moves in gymnastics or similar activities.
Use appropriate protective equipment, such as padded collars and shoulder pads, when competing in contact sports.
Ensure an adequate calcium intake (1000mg to 1500mg a day) with milk and milk products or calcium supplements.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment.
Hospitalization for traction to the skull so the fracture can heal properly.
Whirlpool, ultrasound or massage to displace excess fluid from the injured joint space.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the skull and neck.
POSSIBLE COMPLICATIONS
AT THE TIME OF INJURY:
Shock.
Pressure or injury to the spinal cord and nearby nerves, ligaments, tendons, muscles, blood vessels or connective tissues. AFTER TREATMENT:
Paralysis--temporary or permanent, partial or complete--below the neck.
Delayed union or non-union of the fracture.
Impaired blood supply to the fracture site.
Avascular necrosis (death of bone cells) due to interruption of the blood supply.
Infection in open fractures (skin broken over the fracture site), or at the incision if surgical setting was necessary.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated neck injury.
Unstable or arthritic neck joint following repeated injury.
PROBABLE OUTCOMEThe average healing time for this fracture is 6 to 12 weeks in traction, followed by 2 months in a neck brace. Healing is complete when there is no pain or motion at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Keep the person warm with blankets to decrease the possibility of shock.
DON'T MOVE THE INJURED AREA. Don't try to remove a helmet or other headgear.
Use a stretcher or spineboard with sandbags or a cervical collar to immobilize the neck while transporting the injured person to an emergency facility. Do this only if you are trained in emergency medical assistance or if no help is available.
The doctor will apply traction to manipulate the broken bones slowly back to their original position. Traction lines up and holds the broken neck bones as close to their normal position as possible. Manipulation should be done as soon as possible after injury. Six or more hours after the fracture, bleeding and loss of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position.
Immobilization will be necessary. The best method must be determined by your doctor based on your age, sex and the possibility of spinal-cord injury.
CONTINUING CARETreatment after manipulation and healing:
Take whirlpool treatments, if available.
Massage GENTLY and often to provide comfort and decrease swelling.
MEDICATIONYour doctor may prescribe:
Narcotic or synthetic narcotic pain relievers for severe pain.
Special corticosteroids, such as dexamethasone, to reduce swelling and minimize spinal-cord damage.
Stool softeners to prevent constipation due to inactivity.
Acetaminophen for mild pain.
Antibiotics to fight infection if skin is broken or surgery is needed.
ACTIVITY
Actively exercise all muscle groups not immobilized. These muscle contractions promote fracture alignment and hasten healing.
Resume normal daily activities gradually after treatment.
DIET
Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATION
Begin reconditioning and rehabilitation after clearance from your doctor.
Use ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have any serious neck injury.
You develop signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever) while in traction.
You experience muscle weakness, numbness or complete loss of feeling below the fracture site.
You experience nausea, vomiting or constipation.
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