Lecture 6 - Spinal And Pelvic Injuries Flashcards
Spinal chord
Brain to L1
Cauda equina
L1 to S5
Compression and burst fractures
- fractures of the vertebral body
- compression fractures involve only the anterior column
- burst fractures are ore severe and involve the middle column
Flexion - distracvtion injury
Failure of posterior and middle columns due to hyperflexion force
Fracture-dislocation of the spine
- severest injury and highly unstable
- disruption of all three columns
Treatment varies with stability of injury: from stable to unstable
- activity modification
- physiotherapy
- brace
- external fixation
- internal fixation
- bed rest
Types of collars
- 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
Jefferson fracture
- fracture of the C1 mix
- due to axial compression
- usually stable
- TREATMENTL rigid collar or halovest
Hangman fracture
- C2 injury
- hyperextension
TREATMENT
- halovest
- internal fixation if significantly displaced
Odontoid fracture
- C2
- often in elderly
TREATMENT
- often treated in collar
- internal fixation if significantly displaced
Transverse ligament disruption
C1-2
- forced flexion
- rare: mostly due to congenital abnormality or inflammatory arthropathy
Subaxial cervical burst fracture
- C3-7
- flexion and axial compression
TREATMENT
- collar if no significant kyphosis or cord compression
- often requires surgical reconstruction
Subaxial cervical dislocation
- C3-T1
- hyperflexion injury
- frequently associated with cord injury
TREATMENT
- ASAP reduction
- requires definitive surgical stabilisation
Thoracolumbar compression fracture
T1-L5
- flexion and axial load
- caused by osteoporosis
Thoracolumbar burst fracture
- caused by axial loading
TREATMENT
- managed non-operatively
- surgery required if posterior ligamentous disrupption or neurological compromise
Flexion-distraction injury: Chance fracture
- unstable injury
TREATMENT
- hyperextension cast or internal fixation
Thoracolumbar fracture-dislocation
- caused by rotation and shear
- unstable and commonly neurological injury
TREATMENT
- internally fixed: typically pedicle screw construct
Pelvic fracture
- correlates with high incidence of urinary and vascular injury (may be life threatening)
- uncontrolled hemorrhage may necessitate embolisation
Pelvic avulsion fracture
- ASS
- AIS
- Ischial tuberosity
- posterior sine
- Iliac crest
- sartorius
- rectus feoris
- hamstring
- erector spinae
- abdominal muscles
Lateral compression fracture of pelvis
Stable injury
- common in elderly
TREATMENT
- rest, mobilisation
Open book fracture of pelvis
- unstable injury
- requires fixation
- apply pelvic binder
Vertical shear fracture of pelvis
- requires fixation because unstable
Sacral fracture
Usually stable
TREATMENT: rest, rehabilitation
- may be associated with sacral root injury
Coccygeal fracture
- fall in seated position
Acetabular fracture
- anatomical reduction with internal fixation if displaced
- late total hip replacement surgery may be required to post-traumatic arthritis
