title: Value of a rigid collar in addition to head blocks: a proof of principle study.
abstract: BACKGROUND
  All trauma patients with a cervical spinal column injury or with a mechanism of injury with the potential to cause cervical spinal injury should be immobilised until a spinal injury is excluded. Immobilisation of the entire patient with a rigid cervical collar, backboard, head blocks with tape or straps is recommended by the Advanced Trauma Life Support guidelines. However there is insufficient evidence to support these guidelines.
  
  
  OBJECTIVE
  To analyse the effects on the range of motion of the addition of a rigid collar to head blocks strapped on a backboard.
  
  
  METHODS
  The active range of motion of the cervical spine was determined by computerised digital dual inclinometry, in 10 healthy volunteers with a rigid collar, head blocks strapped on a padded spine board and a combination of both. Maximal opening of the mouth with all types of immobiliser in place was also measured.
  
  
  RESULTS
  The addition of a rigid collar to head blocks strapped on a spine board did not result in extra immobilisation of the cervical spine. Opening of the mouth was significantly reduced in patients with a rigid collar.
  
  
  CONCLUSIONS
  Based on this proof of principle study and other previous evidence of adverse effects of rigid collars, the addition of a rigid collar to head blocks is considered unnecessary and potentially dangerous. Therefore the use of this combination of cervical spine immobilisers must be reconsidered.
authors.affiliation: Department of Orthopaedic Surgery 357, Radboud University Nijmegen Medical Centre, Postbox 9101, 6500 HB Nijmegen, The Netherlands. m.holla@orthop.umcn.nl
authors.forename: M
authors.initials: M
authors.lastname: Holla
mesh_terms: D000328:Adult; D001915:Braces / Q000592:standards* / Q000706:statistics & numerical data; D002574:Cervical Vertebrae / Q000293:injuries* / Q000502:physiology; D004635:Emergency Medicine / Q000379:methods; D005260:Female; D006801:Humans; D007103:Immobilization / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology; D019564:Unnecessary Procedures / Q000295:instrumentation