FRACTURE OF COLLUMNA VERTEBRALIS

Dr. JOHAN BASTIAN SpOT

Orthopaedic dan Traumatologi RSUD KANJURUHAN KEPANJEN

Since 2500 SM USA 1500 case/year 50% road traffic accident, 40% fall from height, 10% sport injury

Vertebral Column :

7 cervical 12 thoracal 5 lumbar 5 sacrum and 5 coccsigeus

History

Preinjury Neurologic Status Mechanism of Injury Changes in Neurologic Status Document

Vertebral Assessment

Pain Tenderness Deformity Edema, ecchymosis Muscle Spasm Tracheal Deviation, Hematoma

Assessment

Neutral position, totally immobilized A,B,C Injury maybe masked Roentgenogram Document Early neurosurgical orthopedic consultation

Spinal Injury

Prevent further injury Presume present of injury until excluded

Management

Immobilized until excluded Intravenous fluids diuretic, steroid Transfer

Immobilization with Collar Neck and Long Spine Board

Management
Intravenous Fluids Treat hypovolemia first Consider neurogenic shock Urinary catheter

Management
Medication Diuretics Steroids
consult Orthopedic Surgeon

Management
Transfer After neurosurgical orthopedic consult Unstable fracture Neurologic deficit Avoid delay Properly immobilized Respiratory support as needed

Suspect Cervical Spine Injury

supraclavicular injury Head injury with/without loss of consciousness

X-RAY INVESTIGATION

Open mouth view Swimmers

Open Mouth View

Indication :
Neck pain / neck injury suspect fractur

Evaluated :
Odontoid Lateralis mass C1 dan C2

Open Mouth View

Open Mouth View

Swimmers View

Swimmers View

Radiographic Guidelines

AP diameter of canal Contour/alignment vertebra Bone fragment displacement Fracture Soft tissue swelling

Lateral C-spine film

Inadequate C-spine film

Adequate C-spine film

Cervical Strain (whiplash)

Soft tissue injury due to sudden hyperextension Anterior longitudinal ligament and iv disc tear

Atlas Fracture (C1)

Involve a blow out of the ring C1 ---> fracture Jefferson Seen best on open mouth view of C1 and C2 area

Bilateral Jefferson fracture (C-1 Atlas)

Axis Fracture (C2)

Odontoid Fracture
Above the base of adontoid (type 1), at the base (type 2) and extends into the vertebral body (type 3).

posterior element fracture of C2 ---> the fracture Hangman

Hangmans fracture

Fracture Dislocation C3 - C7

Mechanism of injury; flexion axial loading, extension axial loading, or flexion rotation injury Level C5 most common site of fracture C5-C6 most common dislocation

Suspect Spine Injury

cervical, thoracal, lumbar

High speed crash Multiple trauma

Radiographic Guidelines

Symmetry of pedicle Height of the disc spaces Alignment of. spinous Proc Shape/contour of vertebral bodies

Thoracic and lumbar spine

Vertebral Thoracal Fracture

Mechanism of injury; wedge compression, burst fracture, fracture dislocation Stable and unstable Cause by fall from height

Vertebral Lumbar Fracture

More mobility than thoracal vertebra Trauma Jack-knife ---> seat belt injury --> Chance Fracture

RO Thoracal (AP)

RO Thoracal (Lateral)

RO Thoracal (Lateral)

RO Thoracolumbal (AP)

RO Thoracolumbal (Lateral)

RO Lumbal (AP)

RO Lumbal (Lateral)

AP

Lateral

Lumbal X-Ray

Wedge compression fracture

8 0 obj

<<

/Linearized 1

/L 20229

/H [ 682 183

/O 10

/E 19263

/N 1

/T 19946

>>

endobj

xref

8 13

0000000017 00000 n

0000000584 00000 n

0000000865 00000 n

0000001090 00000 n

0000003849 00000 n

0000004050 00000 n

0000005014 00000 n

0000005365 00000 n

0000009594 00000 n

0000009790 00000 n

trailer

<<

/Size 21

/Root 9 0 R

/Info 7 0 R

/Prev 19935

>>