The guidelines established by the New York State Workers Compensation Board are designed to assist healthcare professionals in managing Acute Fractures and Dislocations. These directives aim to support physicians and healthcare practitioners in determining the appropriate treatment for individuals experiencing acute fractures or dislocations.
Healthcare professionals specializing in the care of Acute Fractures and Dislocations can rely on the guidance provided by the Workers Compensation Board to make well-informed decisions about the most suitable level of care for their patients.
It is important to stress that these guidelines are not meant to replace clinical judgment or professional expertise. The ultimate decision regarding care for acute fractures and dislocations should involve collaboration between the patient and their healthcare provider.
Decisions on whether surgery is necessary for acute traumatic injuries hinge on the type of injury and the potential for long-term neurological damage. Traumatic injuries can lead to acute disc herniations.
Halo Immobilization
Description: This intervention restricts flexion-extension motion, with the halo vest providing significant but not complete rotational control. It may be effective for treating unstable injuries to the cervical spine.
Complications: Possible complications include pin infection, pin loosening, and palsy of the sixth cranial nerve.
Surgical Indications: Used in cases of cervical fractures requiring nearly complete restriction of rotational control. It helps prevent graft dislodgment, spine malalignment, or pseudarthrosis. The decision to use a halo is at the surgeon’s discretion based on the patient’s specific injury.
Operative Treatment: Involves placing the pins and apparatus
Post-Operative Care: This may include traction for realignment and/or fracture reduction (amount determined by the surgeon), active and/or passive therapy, and pin care.
Anterior and/or Posterior Decompression with Fusion:
Description: This procedure aims to alleviate pressure on the cervical spinal cord and nerve roots, while also focusing on aligning and stabilizing the spine. It may involve using bone grafts, often coupled with spinal instrumentation, to create a firm connection between two or more adjacent vertebrae.
Complications: Possible complications encompass instrumentation failure like screw loosening, plate failure, or dislodgement, bone graft donor site pain, in-hospital mortality, deep wound infection, superficial infection, graft extrusion, cerebral spinal fluid (CSF) leak, laryngeal nerve damage (with the anterior approach), paralysis, and iatrogenic kyphosis.
Surgical Indications: This procedure is recommended when a significant or progressive neurological deficit exists along with spinal canal compromise and/or spinal instability.
Operative Treatment: Both anterior and/or posterior surgical decompression of the cervical spine are widely accepted. The choice is guided by the location of the compressive pathology and the presence of other concurrent injuries.
Post-Operative Care: Post-surgery, cervical bracing, physical therapy, and occupational therapy may be necessary (typically 6 to 12 weeks with fusion). Early rehabilitation should include home programs with instructions in activities of daily living, sitting, posture, and a daily walking regimen. Referral to a formal rehabilitation program, emphasizing cervical, scapular, and thoracic strengthening, and restoration of range of motion, is appropriate once the fusion is solid and without complications. Active treatment, which patients should have undergone prior to surgery, may often need to be repeated. The therapy program’s goals should involve instructing the patient in a long-term home-based exercise regimen.
