Cervical Collar And Lumbar Supports In Pain Management

Orthoses or a kind of splints applied to different parts of body to limit movements which can aggravate the existing pain.

Commonly used orthoses are cervical collars and lumbar supports. Following factors should be taken into account before the orthoses are prescribed.

  • Examination  suggests that supports or reduced mobility benefits the patient.
  • Patient must understand that it is a temporary measure.
  • If the supports aggravates the problem, it should be removed.

[Read more...]

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Hyperextension Casting

Hyperextgension casting is a non operative method to treat thoracolumbar spine injuries where a casthyperextension-cast is applied in position of hyperextension.

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Fracture L3 Vertebra – Lateral Radiograph

29 years lady was sitting in auto rickshaw which was struck by a car from behind. THe woman was thrown out of the auto rickshaw and the auto rickshaw fell on the lady.

She was brought to casualty of our hospital and found have injured her pelvis and spine along with paraplegia.

The xray in picture is lateral view of the spine and shows fracture of L3 vertebra.

MRI of the spine revealed a retropulsed fragment as well. She was operated upon and the spine was stabilized using pedicle screw system.

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Surgery In Thoracolumbar Injuries – Timing and Approches

There is controversy in literature about timing of surgery for thoracolumbar injuries. There is no conclusive evidence that early surgical decompression and stabilization improves neurological recovery, or that a delay in surgery would cause compromised neurological recovery.

However, it is agreed upon that if the neurological deficit is progressive, an emergency decompression is indicated.

Otherwise there are two schools of thought. One advocates early decompression and stabilization. The benefits highlighted are lesser complication rate and shorter duration of hospital stay. [Read more...]

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Treatment Options In Thoracolumbar Spine Injuries – When To Operate and When To Not?

In case of spinal cord injury there is a continuous debate in the literature about operative versus non operative treatment and there are strong adovcates on either side. Because of complex nature of spinal injuries and multiple factors affecting prognosis there are options of treatment available which needs to be individualized in every case.

Broadly speaking, there are two kinds of treatments – non operative and operative.

Before we discuss them further a look into pathophysiology of the cord injury is necessary to grasp the concepts. [Read more...]

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Thoracolumbar Injuries – Susceptibility Of Spinal Cord To Injury

In continuation with spinal canal of cervical spine, spinal canal in thoracic and lumbar spine consists of vertebral body, intervertebral disc, posterior longitudinal ligament anteriorly, pedicles, medial aspect of facet joints on either side laterally and ligamentum flavum & laminae posteriorly.

Injury can cause compromise of the spinal canal and the most common cause is posterior bony retropulsion from a burst fracture of the vertebral body.

Dislocations and fracture dislocations of vertebrae leading to translation between adjacent vertebrae can also cause reduction in canal space. Anterirorly displaced fractures of posterior elements [laminae] can also compromise the canal space.

Postraumatic hematoma formation, disc herniations are other causes of compression following injury.

Lumbar canal stenosis is frequent non traumatic cause of reduction of canal space and neural compromise.

Conus medularis is most distal aspect of the spinal cord and its location varies between T12 and L3. Spinal canal dimensions relative to  spinal cord dimensions are smallest in the T2-T10 region and for this reason the neurologic injury is more commmon after trauma in this region.

Complete spinal cord injury is six times more common than incomplete injury with high-energy trauma to the midthoracic spine .

In addition to smaller canal space,  another factor which is responsible for susceptibility is the lesser vascular supply to the spinal cord. The region between T2 and T10  derives its proximal blood supply from antegrade vessels in the upper thoracic spine and distally from retrograde flow from the artery of Adamkiewicz. [Read more...]

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Total Hip Replacement – Bone Implant Stresses and Factors Governing Them

The implant material, its shape, size and the method of affects the  of stress transfer to the bone. Implant loosening, and  fracture of the femur or the implant are risks that arise from stress transfers to the bone. At the same time stress also provides stimulus for maintaining bone mass.

Modulus of elasticity of the implant material affects the stress that it would cause. A decrease in the modulus of the stem, stem length and cross sectional area  causes a decrease in the stress  in the stem. But it would increase the stress in the proximal third of the cement mass, which transfers these stresses to the surrounding bone. [Read more...]

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Stress Shielding

Stress shielding means a reduction in the bone density as a result of removal of normal stress from the bone by an implant. For example it occurs after hip replacement when the normal bone is replaced by an implant.

This is because in a normal person the bone would remodel in response to the loads it is placed under.

When a hip is replaced as in total hip replacement, the load that was usually placed on the bone would decrease and hence would become less dense.

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What Is Femoral Offset?

Femoral offset is the distance from the center of rotation of the femoral head to a line dissecting the long axis of the femur. In case of  total replacement hip the the offset  is considered  as the  distance from the center of rotation of the femoral head to a line bissecting the long axis of the stem.

Normal femoral offset varies  between 30 amd 60 mm.

Femoral Offset

Image Credit: http://www.traumazamora.org/articulos/offset/offset.html

A decrease in femoral offset would move the femur closer to the pelvis medially. [Read more...]

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Hip Replacement – Mechanics of The Hip

Hip joint biomechanics are quite complex due to pelvic motion associated with it and range of movements it produces.

During normal gait, on heel-strike, the hip moves into 3o degree of flexion and at toe-off [when the foot is finally off the ground] about 10° of extension. The range of abduction to adduction is about 11°, and for internal-external rotation, the range is about 8°.

During different phases of gait cycle, different forces act on femoral head. Approximately two thirds of the hip force is produced by the abductors.

The directions of the resultant force on the joint are important to the function of total hips. [Read more...]

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