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C1/C2 injury

Rob Ojala Rob.Ojala at cdhb.govt.nz
Tue May 31 00:13:49 BST 2011

Question - was the 'tortacollis' you describe persisting AFTER
neuromuscular blockade was established? - ie was there a mechanical
reason beyond muscular spasm creating this neck position?

Two comments- 
1. Rotatory subluxation following self hanging is quite atypical.
2. Physiological rotation in normal individuals at c1/c2 is in the order
of 80 degrees [can provide ref if desired]

Ergo is it worth doing an MRI to see if there is ligamentous rupture to
support a diagnosis of c1-2 instability - because this might all be

Rob Ojala

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Kenneth Mak
Sent: Tuesday, 31 May 2011 1:05 a.m.
To: Trauma-List [TRAUMA.ORG]
Subject: C1/C2 injury

Appreciate advice regarding the management of this cervical injury:

25 year old female, found hanged and immediately brought down. Attended
by paramedics and noted to have PEA - CPR commenced and continued into
hospital ED, ultimately with return of spontaneous rhythm and
circulation, but with fixed and dilated pupils. Intubated but difficult
to maintain inline neck immobilisation due to torticollis.

Post-resuscitation able to maintain haemodynamic status with volume
loading alone. CT head shows diffuse cerebral oedema, CT cervical spine
shows rotatory subluxation of C1 on C2. No obvious fractures noted. Some
scan images enclosed.

Outlook is obviously poor but assuming she had a better outcome, how
should such cervical injuries be managed? I gather these injuries are
seen more commonly in the paediatric population and often in
non-traumatic settings.
Is halo fixation still an option or should C1-C2 fixation be considered?

Kenneth Mak

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