由于骨或韧带完整性的丧失而引起的颅骨不稳定(CVI)是鞭打机制损伤后可能导致的后遗症之一。由于诊断测试缺乏特异性,这种情况经常被遗漏,因此指定了鞭打相关障碍(WAD)的默认分类.此病例报告描述了一个14岁的男孩,该男孩在橄榄球受伤后最初被归类为WADII。最初建议他恢复常规活动,WAD临床指南中推荐的治疗方法.由于对这一行动的不利反应,他的主要照顾者,肌肉骨骼物理治疗师,继续促进二次转诊,最终导致专家物理治疗师。患者随后被发现患有CVI,原因是脊柱裂导致骨完整性丧失,地图集上的先天性缺陷。因此,治疗是固定和稳定,WAD指南中通常建议的治疗方法。患者康复,并在8周内重返学校和非接触运动。这个案例研究,因此,提出了一种无法遵循当前鞭打临床指南的情况,追求临床推理导致准确的诊断以及安全和量身定制的管理。该案例还强调了初级和专科卫生专业人员在WAD后的临床护理路径中应发挥的综合作用。因此,提出了一种扩展的WAD诊断算法和护理途径。
Cranio-vertebral instability (CVI) due to loss of bony or ligamentous integrity is one of the sequelae that may result after a whiplash mechanism injury. Due to the lack of specificity of diagnostic tests, this condition is often missed and the default classification of whiplash associated disorder (WAD) is assigned. This case report describes a 14-year-old boy who was initially classified with WAD II after a rugby injury. He was initially advised to return to usual activity, a treatment recommended in clinical
guidelines for WAD. Due to an adverse response to this course of action, his primary carer, a musculoskeletal physiotherapist, continued with facilitating secondary referrals that ultimately led to a specialist physiotherapist. The patient was subsequently found to have CVI arising from a loss of bony integrity due to spina bifida atlanto, a congenital defect in the atlas. Treatment thus was immobilization and stabilization, a treatment usually recommended against in WAD
guidelines. The patient recovered and within 8 weeks had returned to school and non-contact sports. This case study, therefore, presents a scenario where current clinical
guidelines for whiplash could not be followed, and where pursuing clinical reasoning led to accurate diagnosis as well as safe and tailored management. The case also highlights the integrated roles that primary and specialist health professionals should play in the clinical pathway of care after WAD. As a result, an expanded diagnostic algorithm and pathway of care for WAD are proposed.