2. 17 yo male restrained
driver presents packaged
by EMS, involved in car vs
tree, head-on MVC at
approx 35-40 mph. No
LOC, no airbag
deployment, broken
windshield. Pt did
ambulate on scene. C/o
cervical neck pain.
AFVSS
Gen: WDWN, A&Ox4
HEENT: NC/AT, PERRL,
TMs intact
Neck: C6-C7 CMT without
step-offs, trachea midline.
Neuro: CNs 2-12 intact, Nml
5/5 motor strength and
sensation x 4. Nml reflexes.
MSK: No thoracic/lumbar
TTP/step-offs. No gross signs
of trauma. Long bones and
joints palpated without
tenderness or instability.
5. Lateral C-spine radiograph, or CT
Analgesics
Philadelphia C-collar on discharge to be worn for at
least 10 days
Early follow-up with Orthopedics, 1-2 weeks
Non-operative management if fracture is isolated and
presence of instability has been ruled out
6. Clay Shoveler’s Fracture is considered stable
Caused by intense flexion against a contracted
posterior erector spinal muscle; MC due to
deceleration MVCs
Most common at C7 > C6> T1
If avulsion frx is not limited to spinous process but
extends into lamina, there is greater potential for
spinal cord injury