C-spine fractures
C5 most commonly fractured (relative fulcrum)
C5/6 most commonly subluxed
prehospital assessment
canadian c-spine rule = risk stratification
NICE recommends this be used in ED as well.
high risk
- age 65 years or older
- dangerous mechanism of injury (fall from a height of greater than 1 metre or 5 steps, axial load to the head – for example diving, high‑speed motor vehicle collision, rollover motor accident, ejection from a motor vehicle, accident involving motorised recreational vehicles, bicycle collision, horse riding accidents)
- paraesthesia in the upper or lower limbs
low risk
- involved in a minor rear‑end motor vehicle collision
- comfortable in a sitting position
- ambulatory at any time since the injury
- no midline cervical spine tenderness
- delayed onset of neck pain
- unable to rotate head 45 deg → assess only if patient is already low risk
no risk
- one low risk factor AND
- can actively rotate head 45 deg left and right
imaging in ED
Carry out or maintain full in‑line spinal immobilisation and request imaging if:
- a high-risk factor for C-spine injury, or
- a low-risk factor for C-spine injury present and the person is unable to actively rotate their neck 45 degrees left and right or
- any indication of thoracolumbar spinal injury - see Traumatic spinal fractures
Do not carry out or maintain full in‑line spinal immobilisation or request imaging for people if:
- they have low‑risk factors for cervical spine injury as identified and indicated by the Canadian C‑spine rule, are pain free and are able to actively rotate their neck 45 degrees left and right