Baghdad College of Medicine / 5
th
grade
Student’s Name :
SURGERY
LEC.36 & 38
Dr. Ali B. AL-Hilli
Lec.4&5
Spine Injuries
DONE BY : Mustafa Naser
مكتب اشور لالستنساخ
2016 – 2017
Orthopedics (18&19)
Spine Injuries Dr. Ali B. AL-Hilli
2
@Mustafa Naser 2016-2017
هاي المحاضرات من الحجي الي كالة الدكتور بالمحاضرة ألن مقبل ينطينة المحاضرات
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Mechanism of injury in general :-
1- Avulsion or Traction .
2- Direct injury.
3- Indirect injury :
a) Motor vehicle accident ( seatbelt injury) .
b) Full from a high.
Any patient with multiple injuries has spine fr. Until proved otherwise.
Treated as unstable fr. Until proved otherwise.
If the middle column fractured with either Ant. or Post. Column it is unstable.
Principles of Definitive Management :-
1- Preserve neurological function.
2- Minimize a perceived threat of neurological compression.
3- To stabilize the spine .
4- Rehabilitate the Pt.
Spine Injuries Dr. Ali B. AL-Hilli
3
@Mustafa Naser 2016-2017
Indications Of Urgent Surgical Stabilization :-
1- Unstable fr. With progressive neurological deterioration .
2- Controversy of unstable fr.
Hypotension , Hypothermeia & Bradycardia Patient may have injury
above the level of T6 ( upper spinal cord injury ) .
Non- Contiguous spine injury is common.
Ecchymosis & Abrasion indicate spine injury .
2 injuries could be two parts of movement ( fr. Of calcaneum & spine for
example ).
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C1 fr. ( Atlas ) Jefferson's Fr. :
Mechanism of Cervical spine injury :
Hyperflexion or Hyperextension .
Clinical Features :-
Torticolis ( Deviation of the head laterally ).
Notes :
-X-Ray should include Base of the skull & D1 (T1) " Thotaco-cervical junction ".
- Mechanism of injury of C1 is Axial compression .
- Neurological problem in C1 Fr. Is uncommon , if neurological injury occurs
Death.
-if there is rupture of acetabular Lig. This is unstable Fr.
- if there is overhanging more than 7mm over C2" unstable" .
- Helo-Vest is the most stabilizing conservative method .
Spine Injuries Dr. Ali B. AL-Hilli
4
@Mustafa Naser 2016-2017
C2 Fracture :
Called Hangman's Fr. ( of paris reticularis ) :
Odontoid Fr. : Types :
1- Through the Tip .
2- Through the Base .
3- Through the Body .
Lower Cervical Spine Injuries:-
Mechanism Of Injury : 1- Flexion. 2- Extension. 3- Axial compression.
The Best X-ray is the Dynamic views after :-
1- 100% sure that Fr. Is stable .
2- The Pt. is Conscious .
Tear –drop sign means most unstable Fr. ( mech. axial compression & flexion ).
Cervical – Fracture dislocation Management :
1- Reduction. 2-Relieve compression . 3- Stability
If there is still compression ,that’s mean either it is UNPERFECT or THERE IS
DISC PROLAPSE .
Avulsions is either stable or unstable depending on other spines .
Thoraco-lumbar Injuries :-
3 mechanisms :
1- Compression . 2- Distraction . 3- Rotation " most unstable Fr. " .
Jack- Knife injury :- is unstable injury " seatbelt injury " .
NOTE : we should do Psychological support to paraplegic Pt.
Done By: Mustafa Naser …