Occult Spinal Cord Injury after Blunt Force Trauma in a Patient with Achondroplasia: A Case Report and Review of Trauma Management Strategy

• Published in: The Journal of emergency medicine Vol. 53; no. 4; pp. 558 - 562
• Main Authors: Huecker, Martin, Harris, Zach, Yazel, Eric
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2017
• Subjects: Accidents, Traffic; achondroplasia; Achondroplasia - complications; Adolescent; Cervical Vertebrae - injuries; Humans; Magnetic Resonance Imaging - methods; Male; Motor Vehicles; SCIWORA; special patient population; Spinal Cord Injuries - diagnosis; Spinal Cord Injuries - etiology; Tomography, X-Ray Computed - methods; trauma; Wounds, Nonpenetrating - complications; trauma; achondroplasia; special patient population; SCIWORA
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2017.04.037

Achondroplastic dwarfism is associated with anatomic abnormalities that can predispose to occult injury and challenges in trauma management. Airway anatomy is problematic due to macrocephaly, midface hypoplasia, and a narrow nasopharynx. Manipulation of the neck is very dangerous due to the high likelihood of preexisting cervicomedullary stenosis. Restrictive lung disease and obstructive sleep apnea may complicate respiratory status. Peripheral and central venous access can be difficult to obtain. Orthopedic and metabolic comorbidities can lead to a prolonged hospital course. A 17-year-old male patient with achondroplasia presented to the Emergency Department after a high-speed motor vehicle collision. Despite a negative computed tomography scan of the cervical spine and absence of neck pain, a magnetic resonance imaging evaluation was obtained due to severe neurologic deficits; it revealed disruption of the anterior longitudinal ligament at C2/3 and spinal cord contusion from C3–C6. The patient had a difficult intubation and prolonged weaning from the ventilator after his operation. Emergency physicians must maintain preparedness for all patients and situations, no matter how rare. Prior knowledge of key differences in management of the ABCDs (airway, breathing, circulation, neurological deficit) in patients with achondroplasia will reduce morbidity and mortality.