The feature post for 11/02/2014 (City Trauma) "The beginning of a Trauma System for the Private Sector in the Western Cape?" introduced and discussed the concept of a trauma system in which patients receive appropriate triage and are subsequently transported to the most appropriate hospital based on their injury presentation. This in turn ensures the rapid and most beneficial treatment of injuries, reducing morbidity and mortality.
Although this injury followed a bicycle related incident, the pattern of injury (acute traumatic flexion of the cervical spine) is often seen in other circumstances involving similar mechanisms such as injuries seen on the rugby field, diving accidents and after motor vehicle incidents.
The degree of neuronal damage post injury is dependent on the type and severity of the injury, and the location of the injury in relation to the spinal cord. The diagram opposite shows the correlation of spinal nerves and the level at which they are located, to the area they innovate.
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Although many admissions to the Christiaan Barnard Memorial Hospital Emergency and Trauma Centre arrive via ambulance or private transport following an incident, some admissions follow the referral of patients from other hospitals. The need for patients to be transferred between hospitals may arise due to numerous factors which may include (but not restricted to): upgrade to specialist care; diagnostic requirements; procedural requirements or medical aid constraints.
During the course of a mountain bike ride, a rider fell head-over-handlebars and sustained an immediately obvious spinal injury made evident by a loss of movement of the lower limbs and a limited range of motion of the upper limbs as well as a difficulty experienced during breathing. The rider was unable to move himself post fall, and was initially aided by fellow riders who lay him supine and removed his helmet. Paramedics where called to the incident, and stabilized the rider and provided transportation to the closest facility. However, the facility in question did not have a spinal surgeon on call, and consequently this necessitated the movement of the rider to Christiaan Barnard Memorial Hospital for further assessment and treatment.
Initial diagnostics revealed a dislocation fracture of C5/ C6 (shown in the MRI above left) and an associated neurological deficit including a weakness of the upper limbs with a loss of strength and limited range of motion, and a complete loss of movement in the lower extremities, a condition is referred to a quadriplegia. This necessitated an anterior fusion of C6/C7 and a posterior fusion of C4 - C7 (shown in the x-rays above right).
How best to deal with a possible spinal injury:
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Cycle safety tips:
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An Injury and Prevention Awareness Project brought to you by Christiaan Barnard Memorial Hospital Trauma & Emergency Centre.