Interesting, but if he was totally asymptomatic, then why did he present?
Adrian Fogarty
A&E Consultant
Royal Free Hospital
----- Original Message -----
From: A S Lockey <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, September 13, 2000 11:17 AM
Subject: RE: c-spine injuries
> I know this is only anecdotal evidence but "when I was a lad" and covered
> spinal admissions as an orthopaedic SHO, we had an elderly gentleman
> admitted who had fallen off a ladder 3 weeks previously and had
unknowingly
> sustained a type II peg fracture. He was totally asymptomatic (and rapidly
> placed in a Philadelphia collar, much to his bemusement). I was told at
the
> time by my elders that this is not an unusual presentation.
>
> Andy
>
>
> -----Original Message-----
> From: [log in to unmask]
> [mailto:[log in to unmask]]On Behalf Of Dr F.J. Andrews
> Sent: 13 September 2000 10:16
> To: [log in to unmask]
> Subject: Re: c-spine injuries
>
>
> On Wed, 13 Sep 2000, Dr F.J. Andrews wrote:
>
> >Rowley
> >
> >correct me if I'm wrong but a'grade I' peg injury means just the tip of
> >the peg surely? Grade II would be just above where the peg joins the
> >body of the C2 vertebra and grade III through the body of C2. Grade I
> >(or more correctly type I) injuries are not associated with any
> >neurological damage or instability, as opposed to grade II injuries
> >which ideally require fixation for non-union. My point is that your
> >elderly patient suffered from an inconsequential c-spine injury and
> >failure to x-ray would have not had any adverse consequences for the
> >patient-too often we panic at the sight of an x-ray abnormality in A&E
> >without thinking about what the significance is in terms of stability,
> >potential for neurological problems, definitive treatment and so on. I
> >agree entirely that one
> >should be very suspect of c-spine injuries in the elderly but in my
> >experience a significant injury in an
> >elderly person usually produces some pain in the neck, assuming that
> >they are not confused, intoxicated etc etc. Recently saw an elderly
> >woman having fallen from her chair-neck pain>Xray>type III C2 c spine
> >fracture needing immobilisation.
> >
> >This is my own view, but I'd be interested to hear what others on the
> >list think. Any other adverse experiences out there?
> >
> >Francis Andrews FFAEM
> >
> >
>
>
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