On-field management of potential cervical spine injury in helmeted football players: leave the helmet on!

OBJECTIVE: Improper handling of an unstable neck injury in the prehospital setting may result in potential iatrogenically induced neurologic injury. On-site management of the neck-injured, helmeted football player differs from that of other traumatic cervical spine injuries. Controversy still exists regarding helmet removal protocols for stabilizing the cervical spine of helmeted football players with a suspected neck injury. This article provides a critical review of the scientific evidence on cervical spine management in helmeted football players with a suspected cervical spine injury. DATA SOURCES: A computerized literature search of databases (MEDLINE, Sportdiscus) and a manual search of journals from the sports medicine, emergency medicine, orthopedic, and athletic training literature identified articles related to the topic. Additional references were reviewed from the bibliographies of the retrieved articles. STUDY SELECTION: Conclusions are based on five quasi-experimental study designs evaluating motorcycle, football, and hockey helmet removal. In addition, an attempt was made to correlate articles relating to airway and cervical spine management in general trauma to the helmeted athlete. MAIN RESULTS: Several studies support the recommendation not to remove the helmet or shoulder pads in the prehospital setting unless absolutely necessary. If necessary, both helmet and shoulder pads should be removed together as a unit. There are neither published studies in support of helmet removal nor any case reports of increased morbidity to athletes because of failure to remove the helmet in the prehospital setting. CONCLUSIONS: Although studies support the notion that iatrogenic neurologic deterioration may occur with improper handling and attempted removal of the helmet in the prehospital setting, there is no literature to support increased morbidity associated with not removing helmet and shoulder pads. Stabilization of the cervical spine in an injured football player does not require routine prehospital removal of the helmet and shoulder pads before transport

Stress fracture of the clavicle in a collegiate diver.

PURPOSE: This is the first reported case of a stress fracture of the clavicle in a collegiate diver. CASE SURVEY: A 20-year-old collegiate platform diver developed left clavicular pain after training for several months. Radiographs and radionuclide bone scan supported a diagnosis of a stress fracture of the left midclavicle. Complete fracture healing followed a period of active rest. DISCUSSION: A literature review of clavicle stress fractures is discussed. The open-hand diving technique used by this diver for water penetration may have caused repetitive stresses to radiate up the arm to the clavicle. RELEVANCE: Stress fractures should be considered in the differential diagnosis of clavicular pain in a diver

Management of the helmeted athlete with suspected cervical spine injury.

Improper handling of an unstable neck injury may result in iatrogenic neurologic injury. A review of published evidence on cervical management in the helmeted athlete with a suspected spinal injury is discussed. The approach to the neck-injured helmeted athlete and the algorithms for on-field and emergency department evaluations are reviewed. The characteristics of the fitted football helmet allow safe access for airway management, and helmets and shoulder pads should not be initially removed unless absolutely necessary. Prehospital and emergency personnel should be trained in the indications for removal and in proper helmet, shoulder pad, and facemask removal techniques. If required, both helmet and shoulder pads should be removed simultaneously. Radiographs with equipment in place may be inadequate, and the value of computed tomography and magnetic resonance imaging in these helmeted patients has been studied. If adequate films cannot be obtained with equipment in place, helmet and shoulder pads may need to be removed before radiographic clearance. A plan should be formulated to prepare for such unexpected clinical scenarios as cervical spine injuries, and skills should be practiced. Airway and cervical spine management in these helmeted athletes is an area of ongoing research