spine and pelvic fractures

Question 1

what can occur in the 2nd hour, 24th hour and 48 hours after a spinal cord injury?

Answer 1

• 2 hours after - **oedema leads to ischaemia **(reduced blood flow) and **necrosis begins **
• 24 hours - cord is composed of **mainly necrotic tissue **
• 48 hours later -** lesion is complete**, nerve communication through this point is destroyed

Question 2

what are examples of activties that could cause a cervical spine fracture?

Answer 2

• RTA
• horse riding
• rugby
• diving into shallow water
• fall

Question 3

what are the mechanisms of injury for a cervical spine fracture?

Answer 3

• flexion- common for lower cervical spine
• extension - upper cervical spine
• flexion and rotation
• compression

Question 4

what** region of the spinal column **is most commonly associated with pathologies involving tumours or osteoporosis?

Answer 4

the thoracic spine

Question 5

what are the main MOI’s involved in a thoracic spine fracture?

Answer 5

• flexion or extension movements - hyperextension or hyperflexion movements

Question 6

what are the MOI’s of a lumbar spine fracture?

Answer 6

• flexion and rotation force
• note that it is more stable than the cervical spine

Question 7

describe spinal compression fractures - ie what are they, what movementcan cause this, what are examples of situations that could cause this kind of fracture?

Answer 7

• usually stable
• due to a flexion movement on the spine
• severe fracture if more than 50% of the vertebral height is lost
• eg RTA, fall from height onto head or feet

Question 8

Describe burst fractures - what situation can cause them , stable vs unstable

Answer 8

• typically caused by a fall from height and landing on feet
• stable - neurologically intact, less than 50% anterior body height collapse
• unstable - neurlogical deficity- loss of 50% vertebral body height

Question 9

describe the presentation of a patient with spinal trauma

Answer 9

• 1/3 of spinal trauma patients are symptomatic
• medications of intoxications can mask important features
• SCI’s cause neurological symptoms and the severity of the symptoms depends on the location and level of injury

Question 10

describe the symptoms of a C spine trauma?

Answer 10

• loss of muscle function or strength
• often requires mechnical breathing assistance as chest muscles may also be weakened

Question 11

Describe **T/L spine trauma **

Answer 11

• paralysis and loss of function in the legs and lower body - **paraplegia **

Question 12

what type of paralysis do injuries above C4 cause?

Answer 12

diaphragm paralysis

Question 13

what happens as a secondary response to spinal injury?

Answer 13

• spinal shock - loss of reflec, motor and sensory function below a spinal cord level

Question 14

what is a hangmans fracture?

Answer 14

• fracture of the pedicles in C2 - the axis
• caused by hyperextension - hanging (suicide attempt) or during an rta - chin hits dashboard

Question 15

if the spinal fracture is stable, what does the management involve?

Answer 15

• rigid brace - time dictated by ortho doctor
• relative rest and pain meds

Question 16

what does the management of an unstable spinal fracture involve & compare cervical vs thoracic / lumbar?

Answer 16

• halo (traction) brace for cervical fractures
• surgical stabilisation - for cervical, thoracic and lumbar fractures