Thoracolumbar fractures Flashcards
Initial Post-Traumatic treatment
Stabilize cervical spine, spine precautions, immobilize spine until cleared
Goals from medical perspective
Preserve and improve neurological function, Non operative treatment for stable injuries, Surgical intervention if considered unstable.
Stability
Macroinstability- Gross disruption.
Microinstability- degenerative disorders.
Minor injuries- no brace
Major injuries- brace
Minor- spinous process, t process, pars, facet,
Major- Compression, burst, flexion-distraction, fracture dislocation
Denis Three Column Theory
Anterior- anterior longitudinal ligament to anterior half of vertebral body.
Middle- Posterior half of body to posterior longitudinal ligament.
Posterior- Spinous process, laminae, facets, pedals, ligaments flavum, intra and supra-spinous ligaments.
Compression fx orthotic indications (denis type I)
Non operative- less than 1/3 loss of vertebral body height, single level,
Bed rest, exercise
Orthosis- if less than 50 percent body height at single level, less than 30 kyphosis. Set orthosis in hyperextension. Jewett
-TLSO for multiple levels
Operative- greater than 30 kyphosis and more than 50 percent body loss. Posterior column disruption.
Burst Fracture orthotic indications (type II)
Treatment varies and is controversial
Surgery- anterior decompression.
TLSO- Manage fractures T6-L4
Seat belt injury- flexion distraction orthotic indications
Damage to posterior and middle columns.
one level without ligamentous injury- TLSO in hyperextension.
Surgery for more involved
Fracture dislocation
Failure of all three columns. Shear mechanism involved
Requires surgical stabilization.
Followed by post op orthosis to limit motion, protect surgical equipment, early
Followed by TLSO with thigh extension. set in 20-20 degrees of flexion mobilization and pain reduction.
