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Treatment for lateral flexion fracture dislocation of the cervical spine: report of two cases.

Shiina I, Hioki S, Kamada H, Amano K, Noguchi H - J Rural Med (2010)

Bottom Line: We were unable to obtain good reduction.We did not perform manual reduction.Since closed reduction is sometimes difficult and involves risk, strong internal fixation might be recommended.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Ibaraki Seinan Medical Center Hospital, Japan ; Department of Orthopedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan.

ABSTRACT
The injury mechanism of traumatic cervical spine injury varies, and Allen et al. divide cervical spine injuries into 6 types based on the direction of external force at the time of injury. In this report, we present 2 cases as Lateral Flexion Stage 2. A 51-year-old male (Case 1) was injured in a traffic accident. His conscious level was JCS III-200, and he was found to have a Frankel Grade of B. X-ray revealed a C5/6 fracture dislocation injury of Lateral Flexion Stage 2. We were unable to obtain good reduction. We planned to perform posterior fusion using a cervical spine pedicle screw but could not perform the procedure due to the patient's poor general condition. A 32-year-old male (Case 2) was injured as a result of being hit by a steel sheet. He had Frankel Grade D paralysis. X-ray revealed a C5/6 fracture dislocation injury of Lateral Flexion Stage 2. We did not perform manual reduction. We performed posterior fixation, anterior decompression and anterior fixation. Bone union was confirmed, and the patient was able to return to work. In cases of this type of fracture dislocation of the cervical spine, the supporting structures of the spinal column circumferentially rupture and induce high instability. Since closed reduction is sometimes difficult and involves risk, strong internal fixation might be recommended.

No MeSH data available.


Related in: MedlinePlus

Cervical spine X-ray images of case 2. On the frontal view (left), dilation of theleft facet joint at the level of C5/6 and dislocation of the C5 vertebral body intothe right side were revealed.
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fig_004: Cervical spine X-ray images of case 2. On the frontal view (left), dilation of theleft facet joint at the level of C5/6 and dislocation of the C5 vertebral body intothe right side were revealed.

Mentions: A 32-year-old male had his left mandible smashed into a hanging steel sheet while workingat a construction site (8 m × 1 m). On admission, he had a clear sensorium and normalvital signs. Muscle weakness at level 4 of Manual Muscle Test (MMT) was observed in theregions below the right and left brachial biceps. He was aware of numbness of both upperlimbs. He was diagnosed as Grade D according to the Frankel classification. Contusion,which reached the muscle layer, expanded from the left edge of the mouth to theinframandibular region, but important organs such as the carotid sheath were not injured.A cervical spine X-ray (frontal view) showed dilation of the left facet joint at the levelof C5/6 and dislocation of the C5 vertebral body into the right side (Figure 4Figure 4.


Treatment for lateral flexion fracture dislocation of the cervical spine: report of two cases.

Shiina I, Hioki S, Kamada H, Amano K, Noguchi H - J Rural Med (2010)

Cervical spine X-ray images of case 2. On the frontal view (left), dilation of theleft facet joint at the level of C5/6 and dislocation of the C5 vertebral body intothe right side were revealed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4309361&req=5

fig_004: Cervical spine X-ray images of case 2. On the frontal view (left), dilation of theleft facet joint at the level of C5/6 and dislocation of the C5 vertebral body intothe right side were revealed.
Mentions: A 32-year-old male had his left mandible smashed into a hanging steel sheet while workingat a construction site (8 m × 1 m). On admission, he had a clear sensorium and normalvital signs. Muscle weakness at level 4 of Manual Muscle Test (MMT) was observed in theregions below the right and left brachial biceps. He was aware of numbness of both upperlimbs. He was diagnosed as Grade D according to the Frankel classification. Contusion,which reached the muscle layer, expanded from the left edge of the mouth to theinframandibular region, but important organs such as the carotid sheath were not injured.A cervical spine X-ray (frontal view) showed dilation of the left facet joint at the levelof C5/6 and dislocation of the C5 vertebral body into the right side (Figure 4Figure 4.

Bottom Line: We were unable to obtain good reduction.We did not perform manual reduction.Since closed reduction is sometimes difficult and involves risk, strong internal fixation might be recommended.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Ibaraki Seinan Medical Center Hospital, Japan ; Department of Orthopedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan.

ABSTRACT
The injury mechanism of traumatic cervical spine injury varies, and Allen et al. divide cervical spine injuries into 6 types based on the direction of external force at the time of injury. In this report, we present 2 cases as Lateral Flexion Stage 2. A 51-year-old male (Case 1) was injured in a traffic accident. His conscious level was JCS III-200, and he was found to have a Frankel Grade of B. X-ray revealed a C5/6 fracture dislocation injury of Lateral Flexion Stage 2. We were unable to obtain good reduction. We planned to perform posterior fusion using a cervical spine pedicle screw but could not perform the procedure due to the patient's poor general condition. A 32-year-old male (Case 2) was injured as a result of being hit by a steel sheet. He had Frankel Grade D paralysis. X-ray revealed a C5/6 fracture dislocation injury of Lateral Flexion Stage 2. We did not perform manual reduction. We performed posterior fixation, anterior decompression and anterior fixation. Bone union was confirmed, and the patient was able to return to work. In cases of this type of fracture dislocation of the cervical spine, the supporting structures of the spinal column circumferentially rupture and induce high instability. Since closed reduction is sometimes difficult and involves risk, strong internal fixation might be recommended.

No MeSH data available.


Related in: MedlinePlus