> It's interesting that you (i.e.Gautam) x-ray the worried but well
> population with low risk histories. I rarely x-ray the cervical spine
> of the patient from a low speed RTA for example, even though they
> frequently complain of neck pain. This type of indirect injury (i.e.
> whiplash) is highly unlikely to result in a fracture, perhaps rarely
> seen in very high energy impacts in the osteopenic patient, but I have
> never seen or heard of this mechanism (rear end shunt at low to
> moderate speed) resulting in a fracture, so I no longer x-ray them. The
> exception is where the patient actually hits their face or head on the
> steering wheel or window/B column etc; then they have sustained a more
> "direct" injury to the c-spine (although this is still technically not
> a direct injury) and they will have a more measurable risk of c-spine
> fracture.
>
> Regards
>
> Adrian Fogarty
> A&E Consultant
> Royal Free Hospital
>
>
>
I know I am coming late to this discussion as I catch up with the news while I was on leave,
and I know that Keith Porter is equally sanguine about the benign nature of this injury. I do
have the slides of a patient who did suffer a low Grade I peg # in just the circumstances you
describe, and worse was missed in A&E although she was X-rayed. We had a very sticky few
days (and were fortunately baled out by the orthopaedic surgeons who fussed over her) until
it became clear that she had not suffered any neurological injury. I am not so cavalier in the
elderly any more.
Best wishes,
Rowley Cottingham
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