Pelvic, spinal and sacrococcygeal fractures and luxations Flashcards
Describe what tail pull ( sacrococcygeal luxation) injuries can result in
Neuro deficits- with UMN or LMN deficits
resulting in spastic or atonic bladder
Describe inital assessment after RTA
ABC- airway, breathing and circulation
Radiograph or TFAST/TPOCUS chest
deterimine integrity of urinary tract
Neuro deficits
finally radiograph the pelvis
List some considerations conservative management of pelvic fracture
less invasive
less expensive
outcome less predictable (poorer?)
recovery more prolonged
what is the general principle regarding whether to manage pelvis fracture surgically
usually operate on ilial, acetabular and bilateral fractures
What makes up the weight bearing axis of the pelvis
- the ilial shaf and wing
- the iliosacral articulation
- the acetabulum
Describe a RTA ‘shunting injury’
Sacral fracture and sacroiliac luxation
often have neuro abnormalities- including sciatic neuropathies and urinary incontinence
can be bilateral- very painful if they are
always look for other pelvic fractures
when can sacral fracture and sacroiliac luxation be managed conservatively
if greater than 50% of articular surfaces are in contact
what do you need to do when placing screw to fix sacral fracture and sacroiliac luxation
This screw should engage at least 60% of the width of the sacral body
What generally happens in ilial shaft fractures
caudal fragment often displaces medially narrowing the pelvic canal diameter
List 3 potential complications of ilial shaft fractures
- Reduction can be difficult especially if the injury is chronic (greater than 5 days old)
- Iatrogenic damage to the sciatic nerve is a real risk
- Management of these fractures requires considerable experience
What should we do with acetabular fractures
Refer
Can do:
- Plate fixation
- screws
why are acetabular fractures difficult to manage
Weight bearing is mainly on the dorsocranial aspect of acetabulum
Failing to reconstruct fractures of the caudal third can result in poor outcome despite apparent reduced weight bearing in this area
Describe how to manage pubic fractures
generally pubic fractures require no treatment
Describe spinal fractures
uncommon
often associated with neuro deficits
are very painful
are potentially life threatening
Describe the initial management of spinal fractures
these patients are unstable
ABC
support the back at all times
give analgesia but avoid anaesthesia or deep sedation
where do spinal fractures tend to occur
occur where rigid section of the spine meets a more flexible area
e.g.
T/L junction (the most common site)
L/S junction
C spine
why should you not place animal with spinal fracture under anaesthesia or deep sedation
the muscle spasm and tone provide local support over the fracture site
Describe neuro exam in cases of spinal fractures
assess tone in limbs and tail
where is most marked muscle spasm
is there a perineal reflex
is the patient showing Schiff-Sherrrington
what is Schiff-Sherrington suggestive of
suggestive of cord transection between the fore and hind limbs
what is the most important part of neuro exam in cases of spinal fractures
is there conscious pain perception in the animal
If there is no deep pain sensation the prognosis for the animal is poor
Describe how to approach radiographical evaluation in cases of spinal fractures
Simple lateral views taken of the conscious animal maybe all that is required to determine the nature and significance of the injury
why are fractures involving sacrum significant
because they could have a big effect on urinary and faecal continence
why is the 3 component model used when assessing spinal fractures
If more than one of these components is damaged then the fracture is deemed to be unstable
which spinal fractures can be managed conservatively
Relatively stable fractures and those occurring in the lumbosacral region
describe conservative management of spinal fractures
cage rest for 6-8 weeks
careful nursing
analgesia
Describe the prognosis for spinal fractures
The prognosis for animals with spinal cord injuries is good if conscious nociception is preserved
If not then prognosis is poor
Describe how sacrococcygeal luxations present
Present with a flaccid tail, urinary retention or occasional a flaccid bladder and overflow
Describe how to diagnose sacrococcygeal luxations
Usually fairly straight forward
Distended bladder and flaccid tail with no or little sensation
Always radiograph the chest and pelvis to detect concurrent injuries
Describe how to treat sacrococcygeal luxations
manual expressing of bladder
medications to encourage micturition e.g.
- bethanachol to increase detrusor tone
- Phenoxybenzamine or prazosin to reduce striated muscle tone and dantrolene to reduce smooth muscle tone in the urethra
Describe the prognosis of sacrococcygeal luxations
The prognosis for this injury is good to fair but if there is no improvement after four weeks the prognosis worsens
