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Abstract: The patient in this case is a 57-year-old male. The patient was treated with cervical traction and given ibuprofen extended-release capsules, during which the neck was strictly braked. 1 week later, the cervical fracture site healed well and was discharged from the hospital. 3 months later, the cervical fracture site was well reset and had completely healed.
Basic information】Male, 57 years old
Disease Type】Cervical fracture
Hospital】The First Hospital of China Medical University
Consultation time】October 2020
Treatment plan】Cervical traction + medication (ibuprofen extended-release capsule)
Treatment Period】1 week of hospitalization and regular follow-up
Results】The cervical fracture site was well reset and has completely healed
I. Initial consultation
The patient is a 57-year-old male, who was injured by a wall when the wall was demolished 1 day ago, and felt pain in the head and neck, no numbness and pain in the limbs, no limitation of movement, no dizziness, no nausea, no vomiting, no confusion, no abdominal pain, no numbness in the lower limbs bilaterally. He came to our hospital for further treatment. According to the CT examination report of the health center, the preliminary diagnosis was cervical fracture, and the patient was admitted to our department for treatment. After the injury, the patient was clear, mentally competent, and could eat and drink without urinary or fecal incontinence.
II. Treatment history
On the second day after admission, the patient was ordered to undergo an MRI examination to clarify the extent and scope of the fracture. The results showed that the cervical spine sequence was still neat, the physiological curvature was slightly straightened, and the left posterior edge of the C2 vertebra showed a longitudinal fracture line shadow, the two broken ends were slightly separated, and no spinal cord injury was caused. After comprehensive consideration, it was decided to carry out conservative treatment by traction on the patient’s neck, fixation of the neck with a plaster neck brace, and strict braking of the neck. 1 week later, a CT examination was performed to understand the recovery of the cervical fracture. The patient complained of significant pain and was given ibuprofen extended-release capsules. 1 week later, if the fracture site healing progressed well, the patient could be discharged from the hospital for convalescence and returned to the hospital once a week for review.
III. Treatment effect
After taking ibuprofen extended-release capsules, the patient’s head and neck pain symptoms were significantly relieved. After 1 week of neck traction and wearing a neck brace, the fracture healing progressed well. He was discharged from the hospital for convalescence. X-ray examinations at the 1st, 2nd, 3rd, 6th and 3rd month after discharge showed good recovery of the fracture site, and the 3rd month showed that the fracture was well reset and had completely healed, and the patient had no residual neck discomfort symptoms or neck deformity.
IV. Notes
The patient’s recovery progressed well, and while I was happy for the patient, I did not forget to advise the patient to pay attention to the following points in life after discharge.
1. Diet regulation: the patient’s diet should be light and easy to digest, with attention to the supplementation of calcium, protein, vitamins and other nutrients.
2, neck braking: patients should strengthen the protection of the neck after discharge, do not suddenly low, lift, twist the head and other movements, to trunk lateral rotation instead of neck activities.
3.Timely medical consultation: patients should seek timely medical consultation if they have increased neck pain, numbness of limbs and sensory impairment after discharge.
V. Personal insight
Cervical fracture is one of the most dangerous types of fracture, usually related to external impact. In mild cases, neck pain is the main manifestation, and in severe cases, it can lead to limb numbness, neck deformity, restricted movement and even paralysis, so once neck trauma occurs, one should be alert to the possibility of cervical fracture, go to the hospital in time, and take treatment measures such as repositioning and braking to control the development of the disease. For example, in this case, after the occurrence of cervical trauma, the patient was treated after timely CT examination and clear diagnosis, during which no secondary injury was caused to the fracture site, and the later recovery effect was better.