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Review Question - QID 6805

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QID 6805 (Type "6805" in App Search)
A 36-year-old woman is brought to the emergency department intubated and sedated following a motor vehicle accident. She is moving her upper and lower extremities spontaneously. She cannot follow commands. CT scans are shown in Figures 7a through 7c. The initial survey does not reveal any other injuries. Initial management of the cervical injury should consist of immediate
  • A
  • B
  • C

immobilization with a halo ring and vest with reduction when medically stable.

8%

81/1041

closed traction reduction using Gardner-Wells tongs.

13%

133/1041

posterior open reduction, stabilization, and fusion.

10%

109/1041

cervical MRI followed by reduction.

64%

668/1041

anterior open reduction, stabilization, and fusion.

4%

40/1041

  • A
  • B
  • C

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The patient has a bilateral facet dislocation of C6-C7 with preservation of at least some neurologic function. Urgent reduction is necessary. However, because she is sedated and unable to follow commands, an MRI scan is necessary before any closed or open posterior reduction to look for an associated disk herniation. If a disk herniation is present, it must be removed prior to any reduction maneuver to prevent iatrogenic neurologic injury. It is very unlikely that this injury can be reduced with an open anterior procedure alone.

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