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Neck Fracture

(Broken Neck; Cervical Fracture)

Definition

A neck fracture is a break in one or more of the cervical bones (vertebrae in the neck). The vertebrae are the bones that make up the spine.
A neck fracture is very serious and can lead to paralysis or possibly death. A person with a neck injury should not be moved without competent medical care, which is needed immediately.
It is important to recognize the possibility of a neck fracture. Injuries severe enough to cause head injury or other trauma often also cause neck fracture.
Cervical Spine Fractures
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Causes

A neck fracture is caused by severe trauma to the neck. Trauma includes:
  • Falls, such as from a horse or bike
  • Collisions, such as motorcycle or automobile
  • Diving into shallow water
  • Severe and sudden twist to the neck
  • Severe blows to the head or neck area

Risk Factors

Risk factors for a neck fracture include:
  • Being age 65 years or older
  • Decreased muscle mass
  • Osteoporosis
  • Certain contact sports, such as football or soccer
  • Violence
  • Not wearing your seatbelt when driving in a car
  • Head injury or other traumatic injury such as severe chest trauma, pelvis or femur fractures

Symptoms

Symptoms include:
  • Pain, which may or may not be severe
  • Swelling and bruising
  • Tenderness
  • Decreased feeling in the arms or legs
  • Muscle weakness or paralysis of the arms or legs

Diagnosis

The doctor will ask about your symptoms, physical activity, and how the injury occurred. The doctor will examine the injured area.
Tests may include:
  • X-rays—tests that use radiation to take a picture of structures inside the body, especially bones. It is used to look for a break in the bone or a dislocation of the vertebra.
  • MRI scan—a test that uses a strong magnetic field and radio waves to make pictures of structures inside the neck and back. An MRI provides cross-sectional images that allow the doctor to see if there is damage to the spinal cord.
  • CT scan—a type of x-ray that uses computers to make pictures of structures inside the neck and back. It can be used to analyze bone injury and to see if the spinal cord is compressed by a collection of blood.

Treatment

Treatment depends on:
  • The severity of the fracture
  • If there is an associated dislocation or instability
  • Which cervical bones are broken
  • Whether there is spinal cord or nerve injury, with muscle weakness or paralysis
Treatment includes:

Immobilization

When there is a possibility of a broken neck, complete immobilization of the neck area is necessary. For athletes, it is recommended to keep the helmet and shoulder pads on while immobilizing the spine.

Brace or Collar

A less serious neck fracture can be treated with a cervical brace or collar. It will need to be worn until the neck completely heals, usually 8 to 12 weeks. The doctor may recommend medications to reduce pain and swelling.

Surgery

For a more severe fracture, you may need surgery to realign the bones. Your neck may be placed in traction prior to surgery. A metal plate with screws, or other methods of fixation, may be used to help hold the bones in place.

Exercises

When your doctor decides you are ready, start range-of-motion and strengthening exercises. A physical therapist should assist you with these exercises. Talk with your doctor before returning to any type of physical activity, and about lifting restrictions and other precautions.

Healing Time

You may need to wear a neck splint, spinal brace, or surgical collar for many months. The period of rehabilitation can last many months and even years.

Living with Paralysis

A neck fracture can sometimes result in spinal cord and nerve injury and paralysis. This may require major life changes, involving work, family, and social life. Extensive rehabilitation may be required, including physical and occupational therapy, and psychological support.

Prevention

To help prevent a neck fracture:
  • Do not put yourself at risk for trauma to the cervical bones.
  • Always wear a seatbelt when driving in a car.
  • Wear proper padding and safety equipment when participating in sports or activities.
  • Use proper tackling techniques in football. Do not spear with the helmet.
  • Never dive in the shallow end of a pool.
  • Never dive into water where you do not know the depth or what obstacles may be present.
  • Eat a diet rich in calcium and vitamin D.
  • Do weight-bearing exercises to build strong bones.
  • Build strong muscles to prevent falls and to stay active and agile.

RESOURCES

American Academy of Orthopaedic Surgeons http://www.aaos.org

American Academy of Physical Medicine and Rehabilitation http://www.aapmr.org

CANADIAN RESOURCES

Physical Therapy Canada http://www.physicaltherapy.ca

Department of Orthopaedics University of British Columbia http://www.orthosurgery.ubc.ca

References

American Academy of Orthopaedic Surgeons website. Available at: http://www.aaos.org/. Accessed October 13, 2005.

Bailes JE, Petschauer M, et al. J Athl Train. 2007;42:126-134.

Duane TM, Wilson SP, et al. Canadian cervical spine rule compared with computed tomography: a prospective analysis. J Trauma. 2011;71(2):352-357.

Looby S, Flanders A. Spine trauma. Radiol Clin North Am. 2011;49(1):129-163.

National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/. Accessed October 13, 2005.

Rathlev NK, Medzon R, et al. Evaluation and management of neck trauma. Emerg Med Clin North Am. 2007; 25:679-694.

Yanar H. Pedestrians injured by automobiles: risk factors for cervical spine injuries. J Am Coll Surg. 2007;205:794-799.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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