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The potential for catastrophic head and cervical spine injuries and their life-ending or altering consequences point to the critical need to develop a clear plan for evaluation and management. Fortunately, the overall rate of injury to these body areas is relatively low.1 However, when it does occur, the outcomes can be fatal or result in long-term physical and/or mental deficits.2

Most often the result of direct contact with another player, head injuries occur more frequently in college athletics than in high school and tend to be more frequent in women’s than in men’s sports.3 Sports in which blows to the head are commonplace—football, baseball, and ice hockey—have rules mandating the use of protective headgear. The use of helmets has greatly reduced the number and severity of head injuries in football, but various styles and brands have differing levels of effectiveness.3–6

This chapter focuses on the immediate and follow-up evaluation and management of patients with acute, traumatic head and cervical spine injuries. A well-organized procedure for the emergency management of head and cervical spine trauma is crucial to this process and must be rehearsed regularly by the medical staff to ensure appropriate care. Chapter 14 describes the anatomy of the cervical spine, examination of noncatastrophic cervical spine conditions, and injury to the brachial plexus.


The skull’s design allows for maximum protection of the brain. The density of the bone reduces the amount of physical shock transmitted inwardly. The rounded shape of the skull also has protective qualities. A rounded object tends to quickly deflect blows. For example, consider the difference between dropping a brick on a tabletop versus dropping it on a basketball. When the brick hits the tabletop, it stays there, transmitting its force into the table. When a brick is dropped onto a basketball, although some of the force is transmitted into the ball, the remaining force is dissipated as the brick deflects off the round surface.

Bony Anatomy

With the exception of the foramen magnum, a small opening on the skull’s base through which the brainstem and spinal cord pass, the brain is almost fully encased in bone. In adults, the cranial bones are rigidly fused by cranial sutures, making the skull a single structure (Fig. 20-1). In infants and children, the sutures are more pliable because they are continually being remodeled during growth.


Lateral view of the bones of the skull.

Suspended within cerebrospinal fluid, the brain floats within the cranium. The fluid suspension decreases the mechanical forces transmitted to the brain. In addition, the skin covering the skull increases the cranium’s ability to protect the brain by absorbing and redirecting forces from the skull. The skin greatly increases ...

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