Flash Card 4 - Vertebral fractures

Burst Fracture 
Mc affee - Wedge Compression , Anterior Column injury


Stable Burst - Posterior Column intact

Unstable Burst - All 3 columns involved.


 Unstable Burst fracture

Loss of body height , canal occlusion , angulation , communition

Principle of management

 prevent further neurological damage

 stabilize

 restore anatomy

 early rehabilitation

 minimizes pain and deformity



Chance fracture 

Pure bony injury  .

Posterir to anterior through spinous pedicles and vertebral bodies.
Kyphosis 

 Non  op.

        average 15 degrees ; 3-5 % increase at age around 60

Surgery more than that

          increase more on long segment fixation .



Some authorities also recommend non op meaures in the beginning and do surgery only if people

develop lumbar stenonsis and neruorgenic claudication later.



TLICS

1.Immediate Stability                            Thoracic/Lumbar                              Subaxial/C. vertebrae

Compression                                          1                                                              1

Burst                                                       2                                                              2

Translation                                              3                                                              4

Distraction                                              4                                                              3
 
                                                                         based on CT.

2. PLC Integrity

  Intact                                                    0                                                              0

  Suspected                                             2                                                              1

  Injured                                                  3                                                              2

                                                                        based on MRI


3. Neurological Status 

 Intact                                                   0                                                                 0

Nerve root involved                            2                                                                 1

Complete cord                                     2                                                                 2

Incomplete cord                                  3                                                                  3

Cauda Equina                                      3                                                                 4

                                                                         based on physical examination

Management Decision

0 -3 No surgery

4 surgery choice

> 4 - surgery





PLC - Ligament flavum , articular facet capsules , interspinous ligament, supraspinous ligament
Very strong.






Paraplegia 

who require surgery

  1.a dry lesion

  2.thick dural arachnoid complex


  3. cord small and irregular


  4.cord small and irregular

  5. cord with features of myelomalacia


Who don't require surgery ? 

preserved cord

cord edema , myelitis ,

fluid collection - extradural space











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