Delayed subluxation of an occult traumatic odontoid fracture in an elderly patient.
The issue of whether a traumatic but occult cervical spine fracture can exist has generated significant debate in emergency medicine. The profound clinical and legal implications of missing an unstable cervical spine injury are well known to the emergency care provider. An elderly patient who satisfies all of the rigorous criteria for this type of injury is discussed. The patient experienced delayed subluxation of her acute odontoid fracture during a flexion/extension examination completed in the ED, with resultant development of cervical discomfort. Elderly victims of trauma with an appropriate mechanism of injury should be suspected of subtle or occult neck injuries.
Department of Emergency Medicine, Maine Medical Center, Portland, USA.
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Higgins
D000063:Accidents, Traffic; D000368:Aged; D002574:Cervical Vertebrae / Q000293:injuries*; D004630:Emergencies; D005260:Female; D017102:Fracture Healing; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000209:etiology*; D009460:Neurologic Examination; D011859:Radiography; D016059:Range of Motion, Articular; D016103:Spinal Fractures / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors