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











Comments

Post a Comment

Popular posts from this blog

Outline of Treatment of Spinal Tuberculosis

Image
 Tuberculosis     In general , Rest and Nutrition                                 Chemotherapy                                Surgery if needed .                                    Dorsal Spine - Approach to surgery     A bit ambiguous      Many prefer to do Anterior Transpleural. Some choose Anterolateral/posterolateral extrapleural                and posterolateral approaches      Posterolateral Approach(Martin 1970)      Dura exposed by Hemilaminectomy first and then operation extended laterally to remove posterior         ends of 2 to 4 ribs, corresponding transverse process and pedicles.      He thinks  Anterolateral approach a very risky one.     Approach to Atlanto-occipital and Atlanto-axial joint         Numerous structures on the way anteriorly     Supine position, Neck on 5-10 degrees hyperextension ,Trachesostomy done     Transoral Anterior Approach           Uvula, Soft palate bissected , Hypopharynx packed, 5 cm long incision given, Flaps                                 
Read more

COXA VARA

Image
Coxa Vara Painless limp, LLD gradually worsening ,  Unilateral or bilateral in 30-50 % cases Prominent trochanters Pelvic Tilt- LLD  Trendelenburg test or delaye trendelenburg test + ve B/L waddling  High Greater trochnater - supratrochanteric shortening,  Decreased abduction, (decrease in articular trochanteric distance ) and internal rotation (due to decreased anteversion) may have out toeing r/o cervical instability causing limping  Types of Coxa Vara  https://quizlet.com/au/304405013/coxa-vara-flash-cards/ Mangement      Depends on Hilgenreiner Angle (HEA ) https://www.orthobullets.com/pediatrics/4041/developmental-coxa-vara  > 60 degrees - wait and watch    45-60 degrees - wait and watch  Goals of surgery      Neck shaft angle  (more or equal ) to 140.              degrees     Correct version      Ossification and healing of inferomedial.               fragment      Restore ATD (Articulo-trochanteric            distance    AND abductor mechanism                 (length -tension
Read more

Paediatric Supracondylar Humerus Fracture

Image
Supracondylar Fracture  Patient Presentation         Age 6-10 years         MOI - Fall on outstretched hand with elbow on extension, breaks.   Olecranon serves as the fulcrum      and the stress concentrates in distal humerus. Anteriorly the perisoteum hinges.     Pain , swelling, deformity, bruising      Deformity (usually S shaped ) , skin puckering      Compartment syndrome         Blood vessels spasm/ contusion/ tear/ thrombosis     If capillary refill present , hand arm Dunlop traction done.      No role of Angiography , further delays the treatment.      Nerve Injuries, proximal fragment spike hits nerve.             3a Posteromedial displacement - Radial Nerve involvement             3b Posterolateral displacement - Median Nerve involvement     Gartland and Wilkins Classification      Extension type fracture      1. Undisplaced Fracture      2. Displaced Fracture , posterior cortex is.                intact     3. Displaced fracture, posterior cortex breaks      Flexion type occ
Read more

Timing and Outcome of Surgery in Hip Fractures

Hip Joint Ball and Socket joint. Hip fracture is any fracture involving Interochanteric region head, neck or acetabulum. 310,000 Hip fractures in the United State in 2003     1/3 rd - receive a hip replacement.     10.3 - 15.2 billion dollars / year Elderly – Vast Majority  Co-morbidities Femoral Neck Fracture Fracture Healing is delayed due to          - I ntracapusular neck- No Cambium layer          - Synovial fluid clears out haematoma and inhibits fracture union          - Haematoma causes pressure on head Mechanism of injury  • Directly on lateral hip • Twisting mechanism • Fatigue or insufficiency fracture, then fall • In younger - RTA /  fall from a height Risk Factors of Hip Fractures   • Osteoporosis and Falls   Lifetime risk -17.5 percent for women : 6 percent for men  • Average -   women 77 years old  :  men 72 years old • Low socioeconomic status • Cardiovascular diseas
Read more

Hind Foot amputation

Image
Boyd Amputation -Tibiocalcaneal arthodesis, heel pad preserved. ( https://www.semanticscholar.org/ ) ( Modifizierte Pirogoff-Amputation | SpringerLink ) Pirgoff Amputation  Amputation at ankle. part of calcanuem left in the stump , Calcaneum cut vertically.  Advantages  long lever arm , self suspension , good proprioception , end wt bearing.  Disadvantages  poor cosmesis , too long to use standard foot , no possibility of prosthetic foot fitting 
Read more