Cervical fractures...ow, my broken neck
We got a call the other day at work that our 87 year old Grandma had fallen and broken her neck. Now, this was third hand and no one seemed to know the extent of the break. All they knew is that she was being airlifted to a level 1 trauma center in Seattle for treatment. we were able to talk with the physician that treated her in the community hospital and found out she had sustained a C1-C2 fracture but was still moving, talking, and complaining when she left on the helicopter ride north.
I spent my first 12 or so years in nursing working with backs and heads. I knew where this could head, but also knew that she could have an injury that was survivable and recoverable. It all depended on the details, so to speak. Meaning, just having a fracture itself is not the really bad part. The bad part is what else happened.....muscular tears, additional fractures, vascular injuries, facial fractures, closed or open head injury, and God knows what else.
My partner found Grandma on a stretcher in the ER alone and crying. She hurt, she was scared, she was overwhelmed. She was able to talk to the docs and get a better picture. Grandma was still moving and feeling and they were planning surgery perhaps the next day. This was all good news.
But I had a million other questions...what about spinal cord injury. It was apparent to me that she had not sustained severe spinal cord injury because she still had the ability to move and feel and that the docs were comfortable with delaying the surgery a bit. Other questions might be had it sustained a bruise, did it tear anywhere, could compression be a factor at some point. And what about vascular stuff. the most likely circulatory impairment would be of the vertebral-basilar artery. But there are others, and a lot of them. Sustained circulatory impairment of these could lead to paresis or locked in syndrome and even on to death. What about muscular injury? Tears, seperations, hematomas. Ligament damage? The same concerns.
C1 is also called the atlas. It is a bony ring that does a lot in stabilizing the head. Fracture results in cracks or breaks and may separate the ring into pieces. If it fractures yet the pieces stay in place it is called a burst fracture. but those same breaks can shift and the begin to separate.
I spent my first 12 or so years in nursing working with backs and heads. I knew where this could head, but also knew that she could have an injury that was survivable and recoverable. It all depended on the details, so to speak. Meaning, just having a fracture itself is not the really bad part. The bad part is what else happened.....muscular tears, additional fractures, vascular injuries, facial fractures, closed or open head injury, and God knows what else.
My partner found Grandma on a stretcher in the ER alone and crying. She hurt, she was scared, she was overwhelmed. She was able to talk to the docs and get a better picture. Grandma was still moving and feeling and they were planning surgery perhaps the next day. This was all good news.
But I had a million other questions...what about spinal cord injury. It was apparent to me that she had not sustained severe spinal cord injury because she still had the ability to move and feel and that the docs were comfortable with delaying the surgery a bit. Other questions might be had it sustained a bruise, did it tear anywhere, could compression be a factor at some point. And what about vascular stuff. the most likely circulatory impairment would be of the vertebral-basilar artery. But there are others, and a lot of them. Sustained circulatory impairment of these could lead to paresis or locked in syndrome and even on to death. What about muscular injury? Tears, seperations, hematomas. Ligament damage? The same concerns.
C1 is also called the atlas. It is a bony ring that does a lot in stabilizing the head. Fracture results in cracks or breaks and may separate the ring into pieces. If it fractures yet the pieces stay in place it is called a burst fracture. but those same breaks can shift and the begin to separate.
If they do, the base of support for the weight and stabilization of the head begins to erode, and not evenly in most cases. If there is accompanying muscular injury and rigidity and spasm(which there most often is), those forces can actually work to pull the rings farther apart.
C2 is called the axis. It has a protrusion that extends upward, and actually slips into C1, almost interlocking. This protrusion is called a pedicle. Grandma had broken that off and that was leaning forward and could cause serious damage if not treated. So the answer was surgery for stabilization. C1-C3 posterior fusion.
She made it through surgery ok. Next time, I think I'll go into the spine a bit more.
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