Cervical spine fractures in multiple injured patients in Kurdistan Region, Iraq
DOI:
https://doi.org/10.22317/imj.v5i1.1029Keywords:
CERVICAL SPINE, Fractures, Multiple injured patients, IraqAbstract
Objectives: The aim of study to describe the main types of cervical spine fractures presented to the emergency department and to illustrate the main aspects of management and outcome. Methods: This is a prospective study of 72 patients with cervical injury out of 932 male patients with history of multiple injuries. All patients with cervical spine injury were admitted within 1 week of injury and follow up thereafter by regular outpatient visit. Cervical spine injuries were diagnosed by full radiological assessment according to NEXUS criteria (plain x-ray with lateral, anteroposterior, odontoid views in addition to cervical spine C.T for indicated patients) and evaluated neurologically. Results: Mean age of patients at time of accident was 25 years ranging from 7-73years, 50% of them were in the third decade of life. Road traffic accidents constitute 58.3% of causes of cervical injury followed by fall from height (19.5%). Results has shown that mid and lower cervical spine injuries constitute 87.5% of all types of vertebra involved while upper cervical spine injuries constitute only 12.5% of them. Associated injuries were found in 42 patients (58.3%) and the most common associated injury was cerebral concussion. 50% of patients had no history of neural deficit at time of admission, while the others had neurological abnormalities (27.7%) of them with complete deficit at time of admission. The most common type of skeletal injury was wedge fracture (28 patients, 38.8%), followed by spinous process fracture and burst fracture (18 patients, 25% and 12 patients, 16.6%) respectively. Respiratory complications were the most common in our series (12 patients of 72, 16.6%) followed by an equal share of urinary tract infection and neck pain (7 patients, 9.7%). Conclusion: Traffic accident constitutes the main reason for cervical spine fractures followed by falls. Cervical spine fractures affect the younger age group with mean age of 25 year. A collar is sufficient treatment for more un displaced fractures. Seat belt is one of the restrains that shares in reduction of fatality and severity of cervical spine injuries.
References
2. Dries, D. J. GUIDELINES FOR ESSENTIAL TRAUMA CARE. Shock, 2005, 23, 97–98.
3. Dave S, Cho JJ. Neurogenic Shock. [Updated 2021 Feb 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK4593.
4. Maurin O, de Régloix S, Caballé D, Arvis AM, Perrochon JC, Tourtier JP. Choc neurogénique traumatique [Traumatic neurogenic shock]. Ann Fr Anesth Reanim. 2013 May;32(5):361-3.
5. Blair JA, Possley DR, Petfield JL, Schoenfeld AJ, Lehman RA, Hsu JR; Skeletal Trauma Research Consortium (STReC). Military penetrating spine injuries compared with blunt. Spine J. 2012 Sep;12(9):762-8.
6. Alam Khan T, Jamil Khattak Y, Awais M, Alam Khan A, Husen Y, Nadeem N, Rehman A. Utility of complete trauma series radiographs in alert pediatric patients presenting to Emergency Department of a Tertiary Care Hospital. Eur J Trauma Emerg Surg. 2015 Jun;41(3):279-85.
7. Vahldiek JL, Thieme S, Hamm B, Niehues SM. Incidence of combined cranial and cervical spine injuries in patients with blunt minor trauma: are combined CT examinations of the head and cervical spine justified? Acta Radiol. 2017 Jul;58(7):856-860.
8. Slaar A, Fockens MM, Wang J, Maas M, Wilson DJ, Goslings JC, Schep NW, van Rijn RR. Triage tools for detecting cervical spine injury in pediatric trauma patients. Cochrane Database Syst Rev. 2017 Dec 7;12(12):CD011686.
9. Stiell IG, Clement CM, McKnight RD, Brison R, Schull MJ, Rowe BH, Worthington JR, Eisenhauer MA, Cass D, Greenberg G, MacPhail I, Dreyer J, Lee JS, Bandiera G, Reardon M, Holroyd B, Lesiuk H, Wells GA. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003 Dec 25;349(26):2510-8.
10. Yealy DM, Auble TE. Choosing between clinical prediction rules. N Engl J Med. 2003 Dec 25;349(26):2553-5.
11. Clayton JL, Harris MB, Weintraub SL, Marr AB, Timmer J, Stuke LE, McSwain NE, Duchesne JC, Hunt JP. Risk factors for cervical spine injury. Injury. 2012 Apr;43(4):431-5.
12. Hanson JA, Blackmore CC, Mann FA, Wilson AJ. Cervical spine injury: a clinical decision rule to identify high-risk patients for helical CT screening. AJR Am J Roentgenol. 2000 Mar;174(3):713-7.
13. Darras K, Andrews GT, McLaughlin PD, Khorrami-Arani N, Roston A, Forster BB, Louis L. Pearls for Interpreting Computed Tomography of the Cervical Spine in Trauma. Radiol Clin North Am. 2015 Jul;53(4):657-74, vii.
14. Brohi K, Healy M, Fotheringham T, Chan O, Aylwin C, Whitley S, Walsh M. Helical computed tomographic scanning for the evaluation of the cervical spine in the unconscious, intubated trauma patient. J Trauma. 2005 May;58(5):897-901.
15. Mathen R, Inaba K, Munera F, Teixeira PG, Rivas L, McKenney M, Lopez P, Ledezma CJ. Prospective evaluation of multislice computed tomography versus plain radiographic cervical spine clearance in trauma patients. J Trauma. 2007 Jun;62(6):1427-31.
16. Holmes JF, Akkinepalli R. Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis. J Trauma. 2005 May;58(5):902-5.
17. Brown CV, Antevil JL, Sise MJ, Sack DI. Spiral computed tomography for the diagnosis of cervical, thoracic, and lumbar spine fractures: its time has come. J Trauma. 2005 May;58(5):890-5; discussion 895-6.
18. Karwacki GM, Schneider JF. Normal ossification patterns of atlas and axis: a CT study. AJNR Am J Neuroradiol. 2012 Nov;33(10):1882-7.
19. Raza M, Elkhodair S, Zaheer A, Yousaf S. Safe cervical spine clearance in adult obtunded blunt trauma patients on the basis of a normal multidetector CT scan--a meta-analysis and cohort study. Injury. 2013 Nov;44(11):1589-95.
20. Türedi S, Hasanbasoglu A, Gunduz A, Yandi M. Clinical decision instruments for CT scan in minor head trauma. J Emerg Med. 2008 Apr;34(3):253-9.
21. Kirshblum SC, Biering-Sorensen F, Betz R, Burns S, Donovan W, Graves DE, Johansen M, Jones L, Mulcahey MJ, Rodriguez GM, Schmidt-Read M, Steeves JD, Tansey K, Waring W. International Standards for Neurological Classification of Spinal Cord Injury: cases with classification challenges. J Spinal Cord Med. 2014 Mar;37(2):120-7.
22. Hadley MN, Walters BC, Grabb PA, Oyesiku NM, Przybylski GJ, Resnick DK, Ryken TC. Clinical assessment after acute cervical spinal cord injury. Neurosurgery. 2002 Mar;50(3 Suppl):S21-9.
23. Gerbeaux P, Portier F. [Imaging strategy for cervical spine injury]. Presse Med. 2003 Dec 13. 32(39):1853-6.
24. Uhrenholt L, Charles AV, Hauge E, Gregersen M. Pathoanatomy of the lower cervical spine facet joints in motor vehicle crash fatalities. J Forensic Leg Med. 2009 Jul. 16(5):253-60.
25. Qian BP, Qiu Y, Wang B, Yu Y, Zhu ZZ. [Clinical features and strategies for treatment of spinal fracture complicating ankylosing spondylitis]. Zhonghua Yi Xue Za Zhi. 2007 Nov 6;87(41):2893-8.
26. Demetriades D, Karaiskakis M, Velmahos GC, Alo K, Murray J, Chan L. Pelvic fractures in pediatric and adult trauma patients: are they different injuries? J Trauma. 2003 Jun;54(6):1146-51; discussion 1151.
27. Chan CK, Yau KK, Cheung MT. Trauma survival prediction in Asian population: a modification of TRISS to improve accuracy. Emerg Med J. 2014 Feb;31(2):126-33.
28. Mayo Clinic. Spinal cord injury - Symptoms and causes - Mayo Clinic. Mayo Clinic (2017).
29. Raudenbush B, Molinari R. Longer-Term Outcomes of Geriatric Odontoid Fracture Nonunion. Geriatric Orthopaedic Surgery & Rehabilitation. December 2015:251-257.
30. Stitik, Todd P. MD The Spine, 4th Edition, American Journal of Physical Medicine & Rehabilitation: June 2001 - Volume 80 - Issue 6 - p 432.
31. Riehl JT, Sassoon A, Connolly K, Haidukewych GJ, Koval KJ. Retained bullet removal in civilian pelvis and extremity gunshot injuries: a systematic review. Clin Orthop Relat Res. 2013 Dec;471(12):3956-60.
32. Sarkar D, Demma A, Stulz D, Hsue G. Expect the unexpected: two cases of penetrating head and neck trauma from Operation Iraqi Freedom. Ear Nose Throat J. 2009 Sep;88(9):E19-21.
33. Tollefsen E, Fondenes O. Respiratory complications associated with spinal cord injury. Tidsskr Nor Laegeforen. 2012 May 15;132(9):1111-4.