Acute Phase
Rehabilitation program
Physical therapy
Treat the site of injury with spinal precautions, and address the ABCs. Immobilize the athlete's neck in neutral position with a cervical collar, towel rolls, or whatever is available. Immobilize the spinal column on a backboard, with the head secured such that the entire column is in neutral position and can be moved en bloc. Transport the athlete to a facility with the ability to stabilize the athlete and to radiographically evaluate the neck. [4, 9, 12]
If a fracture is detected, immediately consult a spinal orthopedic surgeon or neurosurgeon. The consultant should make the recommendations regarding the further stabilization of the fracture if needed. This may include Gardner-Wells tongs, surgical intervention, halo immobilization, a cervical collar, or no intervention. The consultant should be a part of all further decisions regarding rehabilitation, return to play, and long-term prognosis.
The patient should rest and remain immobilized, as directed by the consultant. Some patients with very stable fractures may be able to enter an early strengthening and exercise program. [12, 34]
Occupational therapy
Early occupational therapy may help increase function in those with neurologic deficits.
Medical issues/complications
The cervical spine must always be considered injured until proven otherwise by history and physical or radiologic evaluation.
Establishing the ABCs and searching for other injuries are priorities.
Early consultation of a spinal expert is mandatory for patients with fractures.
Surgical intervention
Surgery may very well be necessary, especially in cases of unstable fractures. The consulting surgeon determines whether surgical intervention is necessary.
Consultations
Consult an orthopedic surgeon or neurosurgeon. Other consultants may be contacted, as determined by the patient's injuries. Early psychologic counseling may also be warranted because these injuries may be devastating to the athlete.
Other treatment
Do not remove helmets and shoulder pads on the field if the athlete has a potential unstable cervical injury or if the patient is unconscious. Remove the face guard with a screwdriver or cutters. Athletes with respiratory compromise should be intubated with the helmet on. [2, 35]
Transport the athlete with helmet and pads in place. The chinstrap should remain attached if possible. No cervical collar should be placed, but the athlete and helmet should be secured to a backboard.
Unless the patient can be clinically cleared, obtain plain radiographs while the protective gear is in place. If the radiographs are inadequate, consider CT scanning with the helmet and pads in place. Caution: The helmet and shoulder pads should be removed by individuals who are trained and qualified in their removal. [36]
Recovery Phase
Rehabilitation program
Physical therapy
Treatment is determined by the patient's injuries. An exercise and strengthening program may be initiated, as well as a maintenance program for uninvolved areas. At this time, all involved physicians should discuss the type of sports and activities that the athlete will be able to participate in. If a change in sports or activity is needed, plans to encourage the athlete should begin.
Occupational therapy
Occupational therapy is initiated as determined by the injury and neurologic involvement.
Medical issues/complications
Monitor the athlete for signs of depression.
If the athlete is immobilized, monitor for problems such as skin breakdown or deep venous thrombosis (DVT).
Surgical intervention
The consulting surgeon addresses any potential surgical intervention issues (eg, delayed surgical repair, revisions).
Maintenance Phase
Rehabilitation program
Physical therapy
Treatment is determined by the patient's injuries. Continue exercise and strengthening program, as well as the maintenance program for uninvolved areas. Continue to evaluate the type of sports and level of activity that the athlete will be able to participate in. If a change in sports or activity is needed, plans to encourage the athlete should begin.
Medical issues/complications
See the list below:
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Monitor the athlete for signs of depression.
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If the athlete is immobilized, monitor for potential problems such as skin breakdown or DVT.
Surgical intervention
The consulting surgeon addresses any potential surgical intervention issues (eg, delayed surgical repair, revisions).
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Anteroposterior view of atlantooccipital dislocation.
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Odontoid view of a Jefferson fracture.
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Lateral view of a C2 fracture dislocation.
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Odontoid type 2 fracture.
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Lateral view of type 3 odontoid fracture.
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Computed tomography scans of odontoid type 3 fracture.
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Lateral view of a C3 spinous fracture.
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Lateral view of hangman's fracture.
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C3 flexion fracture.
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C4 burst fracture.
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Clay shoveler's fracture.
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Unilateral locked facets on C5 and C6.
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Bilateral facet fracture/dislocation at C6/C7.
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Child with C6 flexion wedge fracture.
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C7 lamina fracture.
