Missed bilateral radial head fractures in central cord syndrome

In 2012, 22 new major trauma centres were introduced in England. This followed evidence demonstrating that such units saved lives and reduced serious disability. Traumatic central cord syndrome is an example of spinal injury seen in major trauma centres. This condition occurs most frequently as a result of hyperextension to the neck in the presence of spondylosis or degenerative changes. These patients may suffer additional injuries during the initial trauma which may be missed, either due to lack of clinically apparent symptoms or due to the masking of symptoms as a result of neurological compromise.

We describe a case of a 56-year-old gentleman who sustained a traumatic central cord syndrome following a fall down a flight of stairs whilst disembarking an aeroplane. Following transfer from the major trauma centre to the regional spinal injuries centre it was discovered that he had bilateral radial head fractures which had been missed on the initial primary and secondary surveys.

Radial head fractures are a significant injury in the context of traumatic central cord syndrome due to the potential impact on functional recovery and rehabilitation. The tertiary survey has been proposed as a method to detect subclinical injuries in trauma cases. This case highlights the importance of conducting the tertiary survey to avoid missing important subclinical injuries.