Fracture and dislocation of the spine

Cervical spine injury

-                    Neck sprain

  • Treatment
    • Rest
    • heat, soft collar
    • NSAIDs, muscle relaxant analgesic

-                    Whiplash injury

  • Mechanism of injury : hyper extension
  • Clinical feature
    • Neck pain
    • Neck tenderness
  • Investigation
  • Plain radiograph: C-spine AP, lateral
  • MRI
  • Treatment
    • Medication: NSAIDs, muscle relaxant, analgesics
    • Physiotherapy: isometric ,ROM exercise

-                    C1 burst fracture (Jefferson’s fracture)

  • Mechanism of injury
    • axial load
  • Clinical feature
  • Investigation
    • Open mount: overhanging lateral mass > 7 mms.
    • CT scan
  • Treatment
    • Conservative treatment
      • Stable type :semi-rigid collar
      • Unstable type : halo vest
    • Surgical treatment: posterior C1-C2 fusion

-                    Odontoid Fracture

  • Mechanism of injury
    • forced flexion injury
    • hyperextension
  • Clinical feature
    • Neck pain
    • Neuro deficit
  • Classification
    • Type I fracture tip of odontoid
    • Type II junction between odontoid and C2 body
    • Type III C2 body
  • Investigation
  • Treatment
    • Type I : Rigid collar
    • Type II : reduction withposterior fusion

: anterior screw fixation

  • Type III : Halo Vest

-                    Traumatic Spondylolithesis of C2 (Hangman’s fracture)

  • Mechanism of injury
    • extension, compression and flexion
  • Clinical feature
    • Neck pain
    • Neck tenderness
    • neurodeficit
  • Investigation
    • C- spine AP, Lateral Flexion Extension
    • CT scan
  • Treatment
    • Stable fracture : semi-rigid collar
    • Unstable fracture : reduction àhalo vest
  • Mechanism of injury
    • Flexion และflexion-rotation
    • Axial compression
    • Hyperextension
  • Clinical feature
    • Neck pain
    • Neck tenderness
    • neurodeficit
  • Investigation
    • X ray
    • CT scan
  • Treatment
    • Wedge compression fracture : Collar 6-12 weeks
    • Burst fracture
      • No neurodeficit: bed rest with skull traction
      • Neurodeficit: anterior corpectomy with bone graft & plate fixation
    • Fracture-dislocation
      • Reduction with skull traction
      • posterior open reduction & fusion

 

Lower cervical spine fracture

Thoracolumbar Spine Injury

-                    3 column theory

  • Anterior column
  • Middle column
  • Posterior column ( Posterior ligamentous complex)

-                    Mechanism of injury

  • Low-energy fracture
    • Transverse process fracture (avulsion fracture)
    • Pars interarticularis fracture (traumatic spondylolysis)
  • High-energy fracture
    • Compression fracture
    • Axial compression (burst fracture)
    • Flexion-distraction
    • Fracture-dislocation

-                    Investigation

  • Plain X-ray :AP,lateral
    • Loss of vertebral height/wedging
    • Widening of interpedicular distance
    • Widening of interspinous distance
    • Kyphotic angle
  • CT scan
  • MRI

-                    Treatment

  • Stable fracture(compression fracture ที่anterior height loss < , burst fracture ที่ไม่มี neurodeficit และChance fracture
    • thoracolumbar brace หรือbody cast ในท่าextension
  • Unstable fracture(burst fracture ที่มีneurodeficit, flexion-distraction injury และ
    • Operative treatment
  • Fracture with spinal cord injury
    • Operative treatment

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