Introduction Cervical spine fractures and dislocations are uncommon injuries that can have serious neurological consequences. These injuries require adequate stabilisation to prevent further spinal cord injury during transfer between hospitals. Evacuation is often requires a combination of road ambulance, helicopter and fixed wing aircraft from military hospitals. This paper outlines the neck injuries sustained during Op Telic and discusses the need for Halo vests to be available at Role 3.

Methodology The MND(SE) Hospital databases were used to identify all casualties admitted with either a “cervical” or “Neck” injury. The databases covered the period from March 2003 until February 2004. The diagnoses were categorised into minor and serious cervical spine injuries. We defined a serious cervical spine injury as either a fracture or dislocation. We looked at the discharge letters of all casualties evacuated to a Role 4 hospital to confirm whether the casualties had serious cervical spine injuries.

Results 46 casualties were admitted and all were British except 2, who were Iraqi. 33 casualties were returned to their unit for duty or discharged at the airhead on return to the UK. Twelve casualties required hospital treatment. There were 3 serious cervical spine injuries over the study period which included one Hangman’s fracture of C2, one flexion compression injury of C5 and one unifacetal dislocation. All casualties were neurologically intact.

Conclusions 3 casualties were treated at MND(SE) Hospital for serious injuries to the cervical spine. Two patients were transferred without Halo stabilisation after failing to obtain halos in Iraq. One casualty was kept until a halo was flown out from the UK

Recommendations All unstable cervical spine fractures should be stabilised with a halo vest prior to transfer from Role 3. Halo rings and vests should be available at Role 3 facilities.

Objective: Prior to the appointment of a dedicated paediatric orthopaedic consultant at a tertiary referral centre (Feb 1999) the treatment of long bone fractures in paediatric patients with associated head injuries was predominately conservative. Current practice is now for early surgical stabilisation wherever possible. The aim of the study was to assess whether this change in clinical practice had resulted in any alteration in outcome.

Design: A prospective analysis of patients admitted to the paediatric intensive care unit between Feb 1996 and Jan 2002.

Setting: Leeds General Infirmary

Main outcome measures: Duration of ICU admission and time to independent walking was assessed.

Results: A total of 37 patients were included in the study.17 patients were treated conservatively and 19 surgically .A reduction of approximately 30% was observed in ICU stay and time to independent walking was observed in those patients that underwent early surgical stabilisation. Conclusions: Early surgical stabilisation of long bone fractures in head injured children allows quicker rehabilitation