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Application of the Canadian C-Spine Rule during early clinical evaluation of a patient presenting in primary care with a C2 fracture following a motor vehicle collision: A case report

Journal: International Journal of Osteopathic Medicine Date: 2015/09, 18(3):Pages: 230-236. doi: Subito , type of study: case report

Full text    (http://www.sciencedirect.com/science/article/pii/S1746068915000139)

Keywords:

cervical vertebrae [11]
bone fractures [5]
cervical spine [210]
primary health care [59]
differential diagnosis [13]
clinical decision making [21]
case report [514]

Abstract:

Background Neck pain related to a recent minor trauma could mask a cervical spine fracture, even in the absence of neurological signs and symptoms. Objective The purpose of this article is to report a case of safe management of a patient involved in a minor importance motor vehicle collision, concealing an odontoid fracture. Clinical features A patient involved in a minor blunt trauma self-referred to a physical therapist's outpatient clinic the day after, complaining of pain of medium – severe intensity, slight nausea, headache and cervical mobility restriction raised during the night, many hours after the collision. No neurological signs were present. Intervention and outcome A detailed case history which aimed to screen for red flags and the Canadian C-Spine Rule application combined with clinical examination, facilitated the diagnosis of an odontoid fracture of the C2 vertebra. This led to a safe and effective management procedure of the patient and an adequate therapy with a rigid Philadelphia neck brace for 60 days. Conclusion Implementation of the Canadian C-Spine Rule in outpatient clinics can be very helpful to avoid unnecessary imaging and, in the meanwhile, to guarantee safe practice.


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