Complications

What are the potential complications of this fracture?

Because neck fractures often occur in the setting of multiple trauma the complications of other injuries, head trauma, shock, chest and abdominal injuries or long bone fractures may take precedence. Spinal shock in the context of SCI is also a concern. However, assuming that these elements are cared for by the trauma team there are still complications specific to the injury.

Malunion

Malunion occurs when a fracture heals in a bad position. This can occur if reduction is unsuccessful or efforts to hold an unstable fracture fail. In the cervical spine, bad position usally means that the nerves or spinal cord is vulnerable to further injury. This situation is rare. Usually, when the bone heals the stability of the neck is improved even if the new shape is not normal. If malunion occurs where the angulation or displacement is so severe that nerve or cord injury becomes likely, surgery is required to decompress the neurological elements and fuse the spine.

Nonunion

Complete failure to heal (nonunion) is very rare in nonsurgical cases. After most types of fusion operations in the neck healing rates are between 90 & 95% leaving 5 - 10% with nonunion of the fusion (not usually the fracture). If the result is stable and not too painful you may elect to leave this alone. However, the situation can result in breakage of the metal pins and screws by fatigue failure. This is a rare and difficult situation which usually requires repeat surgery to achieve painless healing of the fusion.

Infection

Infection of an operative site occurs with a frequency of between 1/200 and 1/50. Treatment of this situation will always include antibiotics. Ideally, one would like to remove all the metal pieces to help clear up the infection then re-operate to make the situation stable and painless. This may not always to possible and the treatment depends on the individual case.

Progressive Neurological Deterioration

Deterioration of the neurological injury during the course of recovery of the bony injury is a feared complication. Any extension of a cord injury at this level has very serious consequences with further disabilities and a greater risk of mortality. Surgery to attempt to stabilize the spine and prevent this complication may itself damage the spinal cord or its blood supply. The balance is in favor of surgery helping the situation but not always.

Depression

Depression is common and understandable when faced with the change from an active life to one of dependency. It is a fact that spinal cord injured patients lead a full and fulfilling life but the process of coming to terms with the new situation can be very stressful.

Degerative Arthritis

As discussed earlier, the long-term risk of posttraumatic arthritis of the neck is significant. Any change in symptoms years after the original injury should be investigated.