Musculoskeletal Case: neck injury
Paramedics respond to a report of an 82 year old man unconscious after a fall. They find
the patient on the floor in his house in cardiac arrest. His wife said that he fell
approximately 18 inches from a lift assist device. The paramedics revive the patient to a
normal sinus rhythm using ACLS protocols (Advanced Cardiac Life Support) but the
patient remains profoundly unconscious. They fully immobilize his spine and transport
him emergently to the hospital.
X-ray, CT, and MRI image studies at the hospital show C1 and C2 fractures with spinal
cord injury, resulting in quadriplegia. T2-T4 spinous processes and several left ribs are
also fractured. The patient never regains consciousness and dies the next day.
Questions to consider:
1. What is the function of the dens of C2, and why are fractures in this region so
dangerous?
2. What is spinal immobilization, and why is it used?