spine_injury_lx
lumbar spine trauma
introduction
fractures of lumbar spine transverse processes
these may occur in major trauma or falls - particularly onto a blunt object
they are often a marker for abdominal organ injury such as renal trauma
mechanism may be violent muscular contraction or direct trauma
they are said to occur mainly in rotational or extreme lateral flexion injuries
these fractures are generally regarded as being stable and Mx is primarily supportive with analgesia and may require admission for initial analgesia and tertiary trauma survey
1)
flexion injuries
compression fractures
height of the vertebral body is maintained posteriorly but compression of the anterior aspect results in wedge appearance
the most common fracture type, particularly in the elderly or those with
osteoporosis
surgical Mx may be indicated if:
otherwise these are generally stable and rarely cause neurologic problems
axial burst fractures
loss of height of both posterior and anterior aspects of the vertebral body
often caused by a fall from a height and landing on the feet
it is important to assess:
unstable injuries generally require surgery:
significant comminution
severe loss of vertebral body height
canal compromise > 40%
excessive forward bending or angulation at the injury site
significant nerve injury due to parts of the vertebral body or disk pinching the spinal cord
other cases may be treated as for compression wedge fractures
Chance fracture
distraction fracture with the vertebral body pulled apart as in a high speed car accident with pelvis immobilised by a lap seat belt (risk is now much lower with seat belts with a shoulder component), it is now perhaps more common with falls than from car accidents
it is caused by violent forward flexion, causing distraction injury to the posterior elements
mainly occur at T12-L2 (and mid-lumbar region in children)
consists of a compression injury to the anterior portion of the vertebral body and a transverse fracture through the posterior elements of the vertebra and the posterior portion of the vertebral body
~50% of patients with Chance fractures have associated intraabdominal injuries - particularly to pancreas, duodenum, and mesentery
on the lateral films, look for a horizontal fracture through the spinous process, laminae, pedicles and vertebral body
same mechanism of injury may not produce a fracture in children but may still be associated with intestinal and urinary bladder injuries
surgery may be indicated if:
other cases may be managed with a lumbar brace for 12 weeks
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horizontal fissure fracture
Smith fracture
fracture line involves the superior articular processes, the arch, and a small posterior fragment of the sup/post. aspect of the vertebral body
spinous process is intact however, the posterior ligaments are disrupted
fracture dislocation injury
generally caused by rotational injury such as high speed car accidents
all 3 columns of the spine are disrupted
frequently cause serious spinal cord compression and thus require spinal precautions and assessment and Mx of spinal cord injury, and surgical stabilisation
acute traumatic spondylolisthesis
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due to new fracture of the pars interarticularis
usually is associated with major trauma and usually is caused by extreme hyperextension
slip may be present acutely or can occur months to years later as the disk degenerates under shear loads that it cannot sustain
spine_injury_lx.txt · Last modified: 2019/01/08 10:10 (external edit)