Transcript shallow water diving

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~1.2 million HS / 200,000 college & pro
athletes
Largest number of sports-related injuries
among organized team sports in the United
States
Spinal injuries in American football:
Helmet to helmet
 Helmet contact with another body part
 Helmet to ground contact
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Most studied sport
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196 HS and college spinal injuries 1989-2002
Incidence:
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Quadriplegia in 76 (38.8%) patients
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1.10 / 100,000 high school
4.72 / 100,000 college
5.85 /100,000 per year
“Spear” tackling predominant activity resulting
in quadriplegia
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Axial loading > hyperflexion and hyperextension
Boden BP, et al. Catastrophic cervical spine injuries in high school and college football players. Am J Sports Med 2006; 34(8): 1223-1232
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National Football Head and Neck Injury
Registry
> 1300 documented cervical spine injuries
 Anti-spearing rules established in 1976
 88% reduction of spinal injuries by 1994
 Anti-spearing rule coupled with better
coaching of blocking and tackling
techniques has reduced football-related
spinal injuries
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Mueller FO. Fatalities from brain and cervical spine injuries in tackle football: 54 years' experience. Neurologic Athletic Head and Spine Injuries. Philadelphia,
PA: WB Saunders; 2000:242–251.
Vertebral artery injury
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~ 6500 pts / year in US Emergency Depts
High risk of long-term morbidity and
mortality
Male teenagers and young adults
>50% of injuries occur in <4 ft of water
1.2-21% of all spinal cord injuries thought
to be due to diving related injuries
Cervical spine is almost always involved
Almost always axial loading
 Neck is flexed slightly
 +/- hyperflexion
 Body weight generates axial load
 70% are C5–C7
 Flexion teardrop/burst fractures ~60%
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Jefferson Fracture
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Articular facet fracture
Vertebral artery injury
Gravity and
collisions!
Jefferson Fracture
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57 yo diving accident
18 yo skiing accident
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Initial CT
Type III Odontoid and
C7 Spinous Process Fractures
C1-C2 rotatory subluxation
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Sports-related spinal injuries are a
significant source of long-term morbidity
and mortality
Mechanism of injury
Injury pattern
CT = primary imaging modality for the
evaluation of the potentially injured spine
Diagnostic work-up same as for other
more common blunt mechanisms
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What is the estimated pooled sensitivity of
radiography for the detection of cervical spine
fractures?
A. 32%
 Holmes et al 2005 Metaanalysis
B. 52%
 Calculated pooled sensitivity
C. 72%
 Radiography = 52%
D. 92%
 CT = 98%
 Holmes et al. Computed
tomography versus plain
radiography to screen for cervical
spine injury: a meta-analysis. J
Trauma 2005;58(5):902-905
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What is the most common mechanism of injury
for patients with cervical spine fractures
following a shallow water diving injury?
A. Axial loading
B. Axial loading with hyperflexion
C. Hyperflexion
D. Rotation
E. Hyperextension
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What is the most common fracture pattern
involving C2?
A. Hyperflexion burst
B. Hangman fracture
C. Odontoid fracture
D. Articular pillar fracture
E. Hyperextension teardrop
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What is the incidence of spinal cord injuries in
the setting of hyperflexion burst fractures?
A. 65%
B. 75%
C. 85%
D. 95%