J Trauma
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Case Reports Comparative Study
Management of post-traumatic cervical spine instability: operative fusion versus halo vest immobilization. Analysis of 49 cases.
A 5-year retrospective analysis was conducted for all cervical spine fractures associated with neurologic deficit initially treated at the University of Michigan Hospitals. Forty-nine cases of lower cervical spine fracture (C3-C7) were reviewed. Twenty-eight patients underwent early operative fusion followed by immobilization with either halo vests, or hard cervical collars, and 20 patients were initially immobilized in halo vests only. ⋯ Two of these five suffered progression of neurologic deficit secondary to loss of reduction while immobilized. Spinal instability occurred in two of the 28 patients initially fused (7%) (p less than 0.01), and in the patient treated in a collar. The findings indicate: 1) the halo vest does not protect patients with cervical instability from neurological injury, nor does it absolutely immobilize the cervical spine; 2) surgery may be required to provide spinal stability, even after a 3-month orthotic treatment period; and 3) there appears to be an increased rate of spinal stability with fusion and immobilization versus immobilization alone.
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We prospectively evaluated the efficacy of comprehensive field triage in 8,891 trauma patients transported to trauma centers in Dade County, Florida, over a 1-year period ending in September 1986. There were 5,685 males (63.9%) and 3,206 females (36.1%) with a mean age of 32.4 +/- 18.4 years. The overall accuracy for identifying severe injury for the entire group was 30.2%. ⋯ Only nine deaths (0.9%) occurred in 1,004 patients with penetrating trauma whose Trauma Scores were greater than 12. Of the 8,891 patients 4,791 (53.9%) had moderate to severe injury. The overtriage rate was therefore 46.1% using this field categorization system.