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Neck Fracture

Definition

A neck fracture is a break in one or more of the seven cervical bones. The vertebrae are the bones that make up the spine. The cervical vertebrae in the neck are labeled C1-C7. They protect the spinal cord, support the neck, and allow for movement.

It is important to recognize the possibility of a neck fracture.

C1-C7 Fracture Sites
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Causes

A neck fracture is caused by severe trauma to the neck, which is strong enough to break the vertebrae. Trauma may be caused by:

  • Falls
  • Car, motorcycle, or pedestrian collisions
  • Diving into shallow water
  • Severe and sudden twist to the neck
  • Severe blows to the head or neck area

Risk Factors

Factors that may increase your risk of neck fracture include:

  • Falls from heights, such as a ladder, bike, or horse
  • Advancing age
  • Osteoporosis
  • Certain diseases or conditions that result in bone or mineral loss, such as abnormal or absent menstrual cycles, or post- menopause
  • Certain diseases and conditions that weaken bones, such as tumors or cysts
  • Decreased muscle mass
  • Playing certain sports that may result in neck fracture, such as football, rugby, or ice hockey
  • Not wearing your seatbelt or protective sports equipment
  • Head or other traumatic injury, such as severe chest trauma, pelvic or femur fractures
  • Violence

Symptoms

A neck fracture is very serious and can lead to paralysis or possibly death. A person with a neck injury should not be moved without competent medical care, which is needed immediately.

Neck fracture may cause:

  • Severe pain
  • Swelling and possible bruising
  • Tenderness
  • Decreased feeling in the arms or legs
  • Muscle weakness or paralysis of the arms or legs

Diagnosis

You will most likely be taken to a hospital. The doctor will ask about your symptoms, physical activity, and how the injury occurred. The doctor will examine the injured area and perform a complete neurological exam.

Imaging tests evaluate the spine and surrounding structures. These may include:

Treatment

Neck fractures are serious injuries that can lead to paralysis or death. Call for medical help right away.

Immobilize and Stabilize the Injury

When there is a possibility of a neck fracture, immediate and complete immobilization of the head and neck area is necessary. Avoid excessive movement to prevent or minimize spinal cord injury. For athletes, it is recommended to keep the helmet and shoulder pads on while immobilizing the spine.

Once immobilized, you will be assessed for any other problems, such as secondary injuries, shock, or airway obstruction. Stabilizing your injury may include:

  • A breathing tube for a blocked airway
  • IV fluids
  • Admission to the hospital for monitoring

Intial Care

Once you are stabilized and assessed, your course of treatment will depend on:

  • The severity of the fracture
  • Which of the cervical bones are broken
  • Which part of the cervical bones are broken
  • Whether there is temporary or permanent spinal cord or nerve injury

Treatment options for neck fracture include:

  • Neck brace or collar—Minor fractures can be treated with a neck brace or collar for up to 8 weeks. These devices will keep your neck in line while it heals.
  • Traction—Rigid braces or a halo vest worn for up to 12 weeks can be used to treat more severe or unstable fractures. Traction allows for minimal movement beyond what is necessary.
  • Surgery—Plates, screws, or wires may be needed to reconnect bone pieces and hold them in place. Surgery may also be needed to repair vertebrae, relieve pressure on the spinal cord, or remove any damaged vertebral discs.

Overall recovery time depends on whether or not you have any permanent injuries. Physical therapy and rehabilitation can last for months or years.

Hospitalization

People with neck fractures usually need to stay in the hospital. Serious injuries may need to be watched in an intensive care unit. Some people with neck fractures need to have help breathing. A tube is inserted and mechanical ventilation is used to protect and assist breathing.

Medications

You may need the following:

  • Pain medication
  • Antibiotics if an infection is present or possible

Rest and Recovery

Healing time varies by age and your overall health. Children and people in better overall health heal faster. In general, it may take several weeks to several months for a neck fracture to heal.

As you recover, you may be referred to physical therapy to keep your muscles strong. Do not return to activities or sports until your doctor gives you permission to do so.

It is possible that you may have permanent damage or paralysis even if your neck heals. If this is the case, you will need long-term rehabilitation.

Long-term Rehabilitation

A neck fracture can sometimes result in spinal cord and nerve injury and paralysis. This may require major life changes, involving work, family, and social life. Extensive rehabilitation may be required, including occupational therapy, psychotherapy, or support groups.

Prevention

To help reduce your chance of getting a neck fracture:

  • Avoid situations that put you at risk of physical harm.
  • Always wear a seatbelt when driving in a car.
  • Do not drive under the influence of alcohol or drugs.
  • Wear proper padding and safety equipment when participating in sports or activities.
  • Use proper tackling techniques in football. Do not spear with your helmet.
  • Never dive in the shallow end of a pool.
  • Never dive into water where you do not know the depth or what obstacles may be present.
  • Do weight-bearing exercises to build strong muscles and bones.

To help reduce falling hazards at work and home:

  • Clean spills and slippery areas right away
  • Remove tripping hazards such as loose cords, rugs, and clutter
  • Use non-slip mats in the bathtub and shower
  • Install grab bars next to the toilet and in the shower or tub
  • Put in handrails on both sides of stairways
  • Walk only in well-lit rooms, stairs, and halls
  • Keep flashlights on hand in case of a power outage

Revision Information

  • American Orthopaedic Society for Sports Medicine

    http://www.sportsmed.org

  • Ortho Info—American Academy of Orthopaedic Surgeons

    http://www.orthoinfo.org

  • Canadian Orthopaedic Association

    http://www.coa-aco.org

  • Canadian Orthopaedic Foundation

    http://www.canorth.org

  • Bailes JE, Petschauer M, et al. Management of cervical spine injuries in athletes. J Athl Train. 2007;42:126-134.

  • Cervical fracture (broken neck). American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00414. Updated December 2013. Accessed August 21, 2014.

  • Cervical spine injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 20, 2014. Accessed August 21, 2014.

  • Duane TM, Wilson SP, et al. Canadian cervical spine rule compared with computed tomography: a prospective analysis. J Trauma. 2011;71(2):352-357.

  • Looby S, Flanders A. Spine trauma. Radiol Clin North Am. 2011;49(1):129-163.

  • Rathlev NK, Medzon R, et al. Evaluation and management of neck trauma. Emerg Med Clin North Am. 2007; 25:679-694.

  • Spinal cord injury—acute management. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 10, 2013. Accessed August 21, 2014.

  • Spinal cord injury—chronic management. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 11, 2014. Accessed August 21, 2014.

  • Yanar H. Pedestrians injured by automobiles: risk factors for cervical spine injuries. J Am Coll Surg. 2007;205:794-799.