C4C5fracties

C4-C5 fractures refer to injuries at the level between the fourth and fifth cervical vertebrae in the neck. These injuries can involve the vertebral body, posterior elements, or facet joints and may occur with or without dislocation. The C4-C5 segment is part of the mid-cervical spine and plays a role in neck movement and protection of the spinal cord and nerve roots; injury at this level can affect neurological function.

Most C4-C5 fractures result from high-energy trauma, such as motor vehicle crashes or falls, but osteoporotic or weakened bone in older patients can also lead to fractures after low-energy events. Fracture patterns include compression (wedging of the vertebral body), burst, flexion-distraction injuries, and fracture-dislocations. Dislocation at this level increases the risk of spinal cord or nerve-root injury and often requires urgent assessment.

Diagnosis combines clinical evaluation with imaging. Plain radiographs are usually obtained first, followed by computed tomography to define bony injury and stability. Magnetic resonance imaging is valuable for assessing soft-tissue structures, the spinal cord, and potential ligamentous injury. Classification and stability guides treatment decisions.

Management starts with immobilization using a cervical collar or other immobilization device. Stable fractures without neurologic compromise may be treated nonoperatively with immobilization and gradual rehabilitation. Unstable fractures or those with neurological deficit typically require surgical intervention, such as anterior cervical discectomy and fusion, posterior fusion, or a combined approach, to restore alignment and decompress the spinal cord. Early decompression is considered if there is significant neurologic impairment.

Prognosis varies with fracture pattern and neurologic status. Complications can include ongoing pain, instability, nonunion, infection, and, in severe cases, persistent neurologic deficits.