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Management Of Unstable Cervical Spine Injuries In Southern Iraq During OP TELIC
  1. Maj (Retd) JH Bird, MRCSEd1,
  2. Maj DP Luke, MRCSEd RCDM2,
  3. Maj NJ Ward, RAMC3,
  4. Col MPM Stewart, L/RAMC4 and
  5. Maj PA Templeton, FECS (Orth) RAMC (V), Orthopaedic Consultant5
  1. 1Department of Orthopaedics West Middlesex University Hospital, Twickenham Road, Isleworth, TW7 6AF
  2. 2Selly Oak Road, Birmingham, B29 6JD
  3. 3Royal Hospital Haslar, Haslar Road, Gosport, PO12 2AB
  4. 4Orthopaedic Department The James Cook University Hospital, Middlesborough, TS4 3B stewartmpm{at}
  5. 5Department of Orthaepic Surgery The General Infirmary at Leeds Great, George Street, Leeds, LS1 3EX Peter.Templeton{at}


Introduction Cervical spine fractures and dislocations are uncommon injuries that can have serious neurological consequences. These injuries require adequate stabilisation to prevent further spinal cord injury during transfer between hospitals. Evacuation often requires a combination of road ambulance, helicopter and fixed wing aircraft from military hospitals. This paper outlines the neck injuries sustained during Op Telic and discusses the need for Halo vests to be available at Role 3.

Methodology The MND(SE) Hospital databases were used to identify all casualties admitted with either a “Cervical” or “Neck” injury. The databases covered the period from 24 March 2003 until 15 April 2004. The diagnoses were categorised into minor and serious cervical spine injuries. We defined a serious cervical spine injury as either a fracture or dislocation. We looked at the discharge letters of all casualties evacuated to a Role 4 hospital to confirm whether the casualties had serious cervical spine injuries.

Results Forty seven casualties were admitted and all were British except three, two Iraqi civilians and one US soldier. Thirty three casualties were returned to their unit for duty, or discharged at the airhead on return to the UK. Fourteen casualties required hospital treatment. There were five serious cervical spine injuries over the study period which included one Hangman’s fracture of C2, one flexion compression injury of C5, one flexion compression injury of C7, one unifacetal dislocation and one bifacetal dislocation.

Conclusions Five casualties were treated at MND(SE) Hospital for serious injuries to the cervical spine. Two patients were transferred without Halo stabilisation after failing to obtain halos in Iraq. One casualty was kept until a Halo was flown out from the UK.

Recommendations All unstable cervical spine fractures should be stabilised with a Halo Vest prior to transfer from Role 3. Halo Rings and Vests should be available at Role 3 facilities.

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