spine fracture
TRANSCRIPT
FRACTURE OF FRACTURE OF COLLUMNA COLLUMNA
VERTEBRALISVERTEBRALIS
Dr. JOHAN BASTIAN SpOTDr. JOHAN BASTIAN SpOT
Orthopaedic dan Traumatologi RSUD KANJURUHAN KEPANJEN
Since 2500 SM Since 2500 SM USA 1500 case/yearUSA 1500 case/year 50% road traffic accident, 50% road traffic accident,
40% fall from height, 40% fall from height,
10% sport injury10% sport injury
Vertebral Column : Vertebral Column :
7 cervical 7 cervical 12 thoracal 12 thoracal 5 lumbar 5 lumbar 5 sacrum and 5 5 sacrum and 5
coccsigeuscoccsigeus
%âãÏÓ%âãÏÓ
History History
Preinjury Neurologic StatusPreinjury Neurologic Status Mechanism of InjuryMechanism of Injury Changes in Neurologic StatusChanges in Neurologic Status DocumentDocument
Vertebral AssessmentVertebral Assessment PainPain Tenderness Tenderness DeformityDeformity Edema, ecchymosis Edema, ecchymosis Muscle SpasmMuscle Spasm Tracheal Deviation, Hematoma Tracheal Deviation, Hematoma
AssessmentAssessment Neutral position, totally immobilizedNeutral position, totally immobilized A,B,CA,B,C Injury maybe masked Injury maybe masked Roentgenogram Roentgenogram DocumentDocument Early neurosurgical orthopedic Early neurosurgical orthopedic
consultationconsultation
Spinal InjurySpinal Injury
Prevent further injuryPrevent further injury Presume present of injury until excludedPresume present of injury until excluded
ManagementManagement
Immobilized until excludedImmobilized until excluded Intravenous fluids Intravenous fluids diuretic, steroiddiuretic, steroid TransferTransfer
Immobilization with Collar Neck and Long Spine Board
ManagementManagement
Intravenous FluidsIntravenous Fluids Treat hypovolemia firstTreat hypovolemia first Consider neurogenic Consider neurogenic
shockshock Urinary catheterUrinary catheter
MedicatiMedication on
DiureticDiuretics s
SteroidSteroidss
consultOrthopedic
Surgeon
ManagementManagement
TransferTransfer After neurosurgical orthopedic consultAfter neurosurgical orthopedic consult Unstable fractureUnstable fracture Neurologic deficitNeurologic deficit Avoid delayAvoid delay Properly immobilizedProperly immobilized Respiratory support as neededRespiratory support as needed
ManagementManagement
Suspect Cervical Spine InjurySuspect Cervical Spine Injury
supraclavicular injurysupraclavicular injury Head injury with/without loss Head injury with/without loss
of consciousnessof consciousness
X-RAY INVESTIGATIONX-RAY INVESTIGATION
Open mouth viewOpen mouth view Swimmer’s Swimmer’s
Open Mouth ViewOpen Mouth View
Indication : Indication : – Neck pain / neck injury Neck pain / neck injury suspect fractur suspect fractur
Evaluated :Evaluated :– OdontoidOdontoid– Lateralis mass C1 dan C2 Lateralis mass C1 dan C2
Open Mouth ViewOpen Mouth View
Open Mouth ViewOpen Mouth View
Swimmer’s ViewSwimmer’s View
Swimmer’s ViewSwimmer’s View
Radiographic Radiographic GuidelinesGuidelines
AP diameter of canalAP diameter of canal Contour/alignment vertebraContour/alignment vertebra Bone fragment displacementBone fragment displacement FractureFracture Soft – tissue swellingSoft – tissue swelling
Lateral C-spine film
Adequate C-spine filmAdequate C-spine filmInadequate C-spine film
Cervical Cervical SStrain (whiplash)train (whiplash)
Soft tissue injury due to sudden Soft tissue injury due to sudden hyperextension hyperextension
Anterior longitudinal ligament and iv Anterior longitudinal ligament and iv disc teardisc tear
Atlas Fracture (C1)Atlas Fracture (C1)
Involve a blow out of the ring Involve a blow out of the ring C1 ---> fracture JeffersonC1 ---> fracture Jefferson
Seen best on open mouth view Seen best on open mouth view of C1 and C2 areaof C1 and C2 area
Bilateral Jefferson Bilateral Jefferson fracture (C-1 fracture (C-1 Atlas)Atlas)
Axis Fracture (C2)Axis Fracture (C2)
Odontoid Fracture Odontoid Fracture – Above the base of adontoid (type 1), at Above the base of adontoid (type 1), at
the base (type 2) and extends into the the base (type 2) and extends into the vertebral body (type 3). vertebral body (type 3).
posterior element fracture of C2 posterior element fracture of C2 ---> the fracture Hangman ---> the fracture Hangman
Hangman’s fractureHangman’s fracture
Fracture Dislocation C3 - Fracture Dislocation C3 - C7C7 Mechanism of injury; flexion axial Mechanism of injury; flexion axial
loading, extension axial loading, or loading, extension axial loading, or flexion rotation injuryflexion rotation injury
Level C5 Level C5 most common site of most common site of fracture fracture
C5-C6 C5-C6 most common dislocation most common dislocation
Suspect Spine InjurySuspect Spine Injury cervical, thoracal, lumbarcervical, thoracal, lumbar
High speed crashHigh speed crash Multiple traumaMultiple trauma
Symmetry of pedicleSymmetry of pedicle Height of the disc spacesHeight of the disc spaces Alignment of. spinous ProcAlignment of. spinous Proc Shape/contour of vertebral Shape/contour of vertebral
bodiesbodies
Thoracic and lumbar spine
Radiographic Radiographic GuidelinesGuidelines
Vertebral Thoracal Vertebral Thoracal Fracture Fracture Mechanism of injury; wedge Mechanism of injury; wedge
compression, burst fracture, compression, burst fracture, fracture dislocationfracture dislocation
Stable and unstableStable and unstable Cause by fall from heightCause by fall from height
Vertebral Lumbar FractureVertebral Lumbar Fracture
More mobility than thoracal More mobility than thoracal vertebravertebra
Trauma Jack-knife ---> seat belt Trauma Jack-knife ---> seat belt injury ---> injury ---> Chance FractureChance Fracture
RO Thoracal (AP)
RO Thoracal (Lateral)
RO Thoracal (Lateral)
RO Thoracolumbal (AP)
RO Thoracolumbal (Lateral)
RO Lumbal (AP)
RO Lumbal (Lateral)
Lumbal X-Ray
AP Lateral
Wedge compression fractureWedge compression fracture
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