Prehospital Trauma Life Support (PHTLS) Practice Test

An 18-year-old female was struck by a car and has sustained an apparent left femur fracture. Which finding, by itself, does not mandate immobilization of the cervical spine?

1. Fracture of the femur

2. Inability to communicate

3. Mechanism of injury

4. Tenderness over the cervical spine

The correct answer is: Mechanism of injury

In the context of trauma assessment, the mechanism of injury provides crucial insights into the potential for associated injuries, including spinal injuries. However, the mechanism alone does not necessitate cervical spine immobilization. For instance, a high-energy mechanism such as a motor vehicle collision usually raises suspicion for cervical spine injuries, but the presence of such an injury should be evaluated based on other clinical findings. A femur fracture, while serious, does not inherently indicate a cervical spine injury and thus would not alone require immobilization of the cervical spine. Inability to communicate and tenderness over the cervical spine are both indicators of potential neurological compromise or injury, which clearly warrant immobilization to protect the spinal cord from further injury. Effective assessment requires a comprehensive evaluation, where additional definitive signs are considered alongside the mechanism of injury to make informed choices about the management of the spinal injury risk.