Lecture 6 - Spinal And Pelvic Injuries

Question 1

Spinal chord

Answer 1

Brain to L1

Question 2

Cauda equina

Answer 2

L1 to S5

Question 3

Compression and burst fractures

Answer 3

• fractures of the vertebral body
• compression fractures involve only the anterior column
• burst fractures are ore severe and involve the middle column

Question 4

Flexion - distracvtion injury

Answer 4

Failure of posterior and middle columns due to hyperflexion force

Question 5

Fracture-dislocation of the spine

Answer 5

• severest injury and highly unstable

- disruption of all three columns

Question 6

Treatment varies with stability of injury: from stable to unstable

Answer 6

• activity modification
• physiotherapy
• brace
• external fixation
• internal fixation
• bed rest

Question 7

Types of collars

Answer 7

• soft colar
• stiff neck collar
• Miami J collar
• Philadelphia collar
• sternal occipital mandibular immobiliser
• Miami J with chest expansion
• thoraco-lumbo-sacral orthosis
• Halo vest

Question 8

Jefferson fracture

Answer 8

• fracture of the C1 mix
• due to axial compression
• usually stable
• TREATMENTL rigid collar or halovest

Question 9

Hangman fracture

Answer 9

• C2 injury
• hyperextension

TREATMENT

• halovest
• internal fixation if significantly displaced

Question 10

Odontoid fracture

Answer 10

• C2
• often in elderly

TREATMENT

• often treated in collar
• internal fixation if significantly displaced

Question 11

Transverse ligament disruption

Answer 11

C1-2

• forced flexion
• rare: mostly due to congenital abnormality or inflammatory arthropathy

Question 12

Subaxial cervical burst fracture

Answer 12

• C3-7
• flexion and axial compression

TREATMENT

• collar if no significant kyphosis or cord compression
• often requires surgical reconstruction

Question 13

Subaxial cervical dislocation

Answer 13

• C3-T1
• hyperflexion injury
• frequently associated with cord injury

TREATMENT

• ASAP reduction
• requires definitive surgical stabilisation

Question 14

Thoracolumbar compression fracture

Answer 14

T1-L5

• flexion and axial load
• caused by osteoporosis

Question 15

Thoracolumbar burst fracture

Answer 15

• caused by axial loading

TREATMENT

• managed non-operatively
• surgery required if posterior ligamentous disrupption or neurological compromise

Question 16

Flexion-distraction injury: Chance fracture

Answer 16

• unstable injury

TREATMENT
- hyperextension cast or internal fixation

Question 17

Thoracolumbar fracture-dislocation

Answer 17

• caused by rotation and shear
• unstable and commonly neurological injury

TREATMENT
- internally fixed: typically pedicle screw construct

Question 18

Pelvic fracture

Answer 18

• correlates with high incidence of urinary and vascular injury (may be life threatening)
• uncontrolled hemorrhage may necessitate embolisation

Question 19

Pelvic avulsion fracture

• ASS
• AIS
• Ischial tuberosity
• posterior sine
• Iliac crest

Answer 19

• sartorius
• rectus feoris
• hamstring
• erector spinae
• abdominal muscles

Question 20

Lateral compression fracture of pelvis

Answer 20

Stable injury
- common in elderly

TREATMENT
- rest, mobilisation

Question 21

Open book fracture of pelvis

Answer 21

• unstable injury
• requires fixation
• apply pelvic binder

Question 22

Vertical shear fracture of pelvis

Answer 22

• requires fixation because unstable

Question 23

Sacral fracture

Answer 23

Usually stable

TREATMENT: rest, rehabilitation

• may be associated with sacral root injury

Question 24

Coccygeal fracture

Answer 24

• fall in seated position

Question 25

Acetabular fracture

Answer 25

• anatomical reduction with internal fixation if displaced

- late total hip replacement surgery may be required to post-traumatic arthritis