Cervical Injury In a Age Group Ironman Triathlon Athlete

Abstract

HISTORY: A 50-year-old female triathlon athlete suffered a high energy head trauma after a bicycle fall during training. She remained conscious and complaining of pain in the neck. She suffered a cut on the forehead and some skin abrasions on the upper and lower limbs. There was no numbness, tingling, weakness or radiation of pain into her upper extremities. The PHTLS protocol was applied and she was immediately forwarded to local major trauma hospital. PHYSICAL EXAMINATION: Examination on the emergency room revealed intense tenderness of the adjacent right paraspinal muscles over the region of C6. There was no neurological impairment or abnormality on reflexes, sensibility or strength on the upper extremities. DIFFERENTIAL DIAGNOSIS: 1. Fracture of cervical spine. 2. Strain of cervical paraspinal muscles. 3. Cervical sprain. TEST AND RESULTS: Cervical spine anterior-posterior and lateral radiographs: - Suggestive findings of fracture of the C6 transverse process. - Moderate stage of osteoarthritis on all cervical spine segments. Cervical spine Computerized Tomography (CT): - Transverse fracture of the right C6 transverse process without signs of instability. - No injuries involving the spinal canal or the intervertebral foramina. FINAL WORKING DIAGNOSIS: Stable transverse fracture of the right C6 transverse process. TREATMENT AND OUTCOMES: 1. Immobilization with Philadelphia collar for 6 weeks. 2. Physical therapy and osteopathy aiming to keep stretching and strength since the first week. 3. Progressive intensity of specific triathlon training started 5 weeks post injury. 4. Age group World Ironman Competition 2014 finished in 13:47 after only 12 weeks post injury.