Cervical fracture
A fracture of any of the seven cervical vertebrae in the neck.
A cervical fracture, also known as a broken neck, involves a break in one of the seven cervical vertebrae located in the neck. This injury is dangerous because abnormal movement of the bones or bone fragments can damage the spinal cord, potentially causing loss of sensation, paralysis, or death. While high cervical injuries (e.g., C1-C3) can lead to rapid respiratory arrest, many cervical fractures do not cause immediate death, and survival times vary widely depending on the level and severity of spinal cord injury.
The frequency of cervical fractures varies by country. A Norwegian study estimated about 15 cases per 100,000 people each year, with more men affected than women. Overall, the incidence has been rising in recent decades, especially among the elderly. Data from the U.S. shows an increase in surgical fracture rates, particularly in people aged 80 and older. The cause of injury differs by age and setting. In older adults, falls—even from ground level—are the most common cause. The risk of cervical spine fracture rises significantly with age. In younger people and in low-income countries, high-energy trauma like vehicle collisions is more typical.
The cervical spine is highly mobile despite its biomechanical demands. Different forces, such as hyperflexion or hyperextension, can cause fractures, and specific fracture patterns often correspond to particular forces. Patient factors like age and bone quality also influence the type of fracture. Contact sports carry a risk of cervical fracture, including American football, soccer (especially for goalkeepers), ice hockey, rugby, and wrestling. Spearing an opponent in football or rugby can break the neck. Non-contact sports like gymnastics, skiing, diving, surfing, powerlifting, horseback riding, mountain biking, and motor racing also pose a risk. Penetrating neck injuries can cause cervical fractures and may lead to internal bleeding. Execution by hanging is designed to produce a fatal cervical fracture; the noose knot is typically placed behind the ear (often under the left ear) to induce a hyperextension injury, though the exact mechanics can vary and the description of the head jolting 'sharply upwards and to the right' is not a universally established fact.
For diagnosis, a medical history and physical exam can sometimes clear the cervical spine without imaging. Clinical prediction rules like the Ca
- incidence
- approximately 15 per 100,000 people per year (Norwegian study)
- common_causes
- traffic collisions, diving into shallow water, falls, sports, hanging
- male_predominance
- yes
- rising_trend
- overall incidence rising, especially in elderly (≥80 years)
- classification_types
- Jefferson fracture, Hangman's fracture, flexion teardrop fracture
Lore & Background
Cervical fractures can result from various traumatic forces such as hyperflexion or hyperextension. Specific fracture patterns often correspond to specific forces, and patient factors like age and bone quality influence the type of fracture. In younger populations and low-income countries, high-energy trauma such as vehicle collisions are more common causes, while in the geriatric population, ground-level falls are the most common mechanism.
Reader's Guide
Cervical fractures are significant because they can lead to catastrophic spinal cord injury, including paralysis or death within minutes. Diagnosis involves medical history, physical examination, and imaging such as CT or X-ray, with clinical prediction rules like the Canadian C-spine rule and NEXUS guiding imaging decisions. Treatment emphasizes early immobilization to prevent further injury, using cervical collars, rigid braces, traction, or surgery. Non-steroidal anti-inflammatory drugs are contraindicated due to interference with bone healing. Historical treatments date back to Hippocrates and Ibn al-Quff, but modern spinal surgery developed in the 19th century with the introduction of anesthesia.
Did You Know?
- A cervical fracture can cause death, but survival times vary widely depending on the level and severity of spinal cord injury; high cervical injuries (e.g., C1-C3) can lead to rapid respiratory arrest, while many fractur
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