Cervical Fractures Stenberg College Nursing students 2014

What is a cervical fracture?  A cervical fracture is a break in one or more of the seven cervical vertebrae in a patient’s neck.  Cervical vertebrae supports one’s head, allowing the neck to bend and twist.  The Vertebrae is a protective wall that protects the spinal cord.

 The majority of cervical fractures are caused by sudden, forceful impact.  Other most commons include:  Motor vehicle accidents  Falls  Dives into shallow water  Injuries from contact sports  Skateboarding injuries Causes of a cervical fracture

 Pain, tenderness, swelling, or muscle cramps in the neck  Trouble swallowing  Problems moving your neck  Numbness, pain, or tingling at the base of your head  Loss of feeling or pinprick in the legs or arms  Double vision or loss of consciousness Signs and Symptoms

 Odontoid fracture  Hangman’s fracture  Jefferson fracture  Teardrop fracture  Diagnosing: CT scan, MRI, and x-ray which are typically done in the emergency department. Common types of cervical fractures

Odontoid fracture  The odontoid is a part of your C2 vertebrae, also known as the axis.  When the odontoid breaks, one can not twist and turn their neck freely.  This type of fracture is quite common in children

Hangman’s fracture  Another type of fracture involving a break in the axis.  Results from hyperextension and distraction

Jefferson fracture  Consists of three or four breaks in the C1 vertebrae, AKA the atlas.  Bones in the axis may also be broken

Teardrop fracture  This type of fractures are large, triangle-shaped breaks in one or more of the lower cervical vertebrae.  They can also affect nearby ligaments and discs.

Preoperative assessment for positioning needs should be made before transferring the patient to the bed. This is especially important when the patient has a cervical spine injury to prevent further damage to the cord. Maintenance of spinal immobilization throughout the transfer process is essential while keeping in mind that a cervical collar alone doesn’t completely immobilize the spine. Educating nurses

 Prepare the bed as for the cervical halter traction. Use an alternating pressure mattress, if one is available, when the patient is in a conventional bed.  The patient in tong traction may be immobilized for a long period of time, so he may be placed on a Foster frame. Educating nurses cont.

 Do not move the tongs that have been inserted in the parietal area of the skull and the tong is then attached to the pulling device.  Use the “log roll” for in turning, bed making and back care.  Feed the patient slowly and with great care. Allow plenty of time to chew and swallow. Keep suction equipment at the bedside for emergency use. Educating nurses cont.

 Preoperative assessment should include assess the patient for condition that will effect proper positioning or lead to intraoperative complications such as: extremes of age, degenerative changes or poor skin integrity. Preoperative Assessments

 Moving the patient should be a coordinated approach, with a person preferably the team leader coordinating all moves.  Manual immobilization is much more effective than any external immobilization.  Using a team of four or more and logrolling the patient will make a transfer smooth and be effective in reducing the risk of pressure ulcers.  Use of sled Moving and positioning

Types of traction  Halo traction- typically used to stabilize cervical spine fractures.  Once proper alignment has been established, a halo vest is often applied to provide ongoing immobilization of the cervical.

Nursing Alert!  The nurse must never remove weights from skeletal tractions unless a life-threatening situation occurs or Doctors orders. Removal of the weights completely defeats their purpose and may result in injury, infection, severe pain, nerve and mussel damage, and further spinal injury to the patient.

Maintain integrity of the halo external fixation device.  a. Inspect pins and traction bars for tightness; report loosened pins to physician.  b. Tape the appropriate wrench to the head of the bed for  emergency intervention.  c. Never use the halo ring to lift or reposition the client.  Loosening of the apparatus poses the risk of further damage to the cord. It is the responsibility of the nurse to maintain the integrity of the apparatus and the safety of the client. Nurses responsibility

Assess muscle function and skin sensation every 2 hours in the acute phase and every 4 hours thereafter.  a. Assess motor function on a scale of 0 to 5, with 0 being no evidence of muscle contraction and 5 being normal muscle strength with full range of motion.  b. Assess sensation by comparing touch and pain, moving from impaired to normal areas, and testing both the right and left sides of the body. Monitoring muscle function and skin sensation allows early identification of potential neurologic deficits. Responsibilities cont…

Monitor pin sites each shift and follow hospital policy for pin care. Here are some general guidelines.  a. Assess pin sites for redness, edema, and drainage.  b. Depending on policy, clean each pin site with a sterile applicator dipped in hydrogen peroxide, apply a topical antibiotic, and cover with sterile 2-inch split gauze squares. Organisms can enter the body through the pin-insertion site; assessments and care are provided to detect signs of and prevent infection Nurses responsibilities cont..

Maintain skin integrity. a. Turn the immobile client every 2 hours. b. Inspect the skin around edges of the vest every 4 hours. c. Change the sheepskin liner when it is soiled and at least once each week. These interventions prevent skin injury and irritation. Responsibilities cont…

 Insufficient padding, inappropriate vest size, or poor application can result in skin breakdown and resultant pressure sores.  Pressure sores usually develop underneath the vest because of the pressure against a bony prominence.  The scapula and along one’s spine are common places for skin breakdown.  This can be prevented by adequate padding turning and repositioning.  Daily care of the vests should include meticulous skincare and assessment to assess for early signs of skin irritation. Skin Breakdown and Pressure Sores

 5/halo_fixation.pdf\ 5/halo_fixation.pdf\  tm tm  060#sthash.Qp09tbfj.dpuf 060#sthash.Qp09tbfj.dpuf  0Muscle/MS%202.pptx References