Lumbar Spine-Biomechanics of the Intervertebral Disc

Intervertebral disc is a structure that is present between two bodies of adjoining vertebrae. Each component of the intervertebral disc has a specific histologic composition and structure that is responsible for a specific function. The vertebral end plates that are in direct contact wiith disc, consist of cortical bone in the periphery, which in adolescence is referred to as the ring apophysis, and compressed cancellous bone in the central disk area, which covers nearly 70% of the disk. Read more

Lumbar Spine-Morphologic and Functional Anatomy

The lumbar spine is a unique bony and ligamentous structure. It can withstand excessive loads while simultaneously protecting neurologic function and providing flexibility and stability.
This intricate interplay between the different anatomic components of the lumbar spine provides efficient motion and function that enables us so much mobility.

The five vertebral bodies and intervertebral disks of the lumbar spine withstand significant physiologic loads. The intervertebral segment of the lumbar spine consists of a three-articulation complex, the disk-vertebral body and two posterior apophyseal (facet) joints, to resist these high loads and stresses.

The vertebral bodies are a cylindrical mass of cancellous bone with a cortical shell. In between are the discs consisting of the anulus fibrosus, the nucleus pulposus, and the cartilaginous and bony end plates of the vertebral bodies.

The vertebral bodies and discs from the anterior column of the spine, which is responsible for resisting approximately 80% of axial compressive loads and maintaining spinal rigidity and alignment.

The intervertebral disc maintains separation of the vertebral bodies. Read more

Acetabular Fractures-When They Should Be Operated?

For most displaced acetabulum fractures, surgical reduction is indicated with an aim to decrease the incidence of posttraumatic arthritis.

It also permits the patient to return to normal function earlier than nonoperative treatment.

Nonoperative treatment used in a minority of displaced acetabulum fractures. Indications for nonoperative treatment are based on

• Patient condition
• Fracture configuration
• Congruence of the hip joint.

Nonoperative treatment is reserved for patients with nondisplaced fracture, those with tolerable incongruity or displacement, and those in whom surgery is contraindicated. Read more

An Introduction To Acetabular Fractures

Inominate Bone has two coulmns -anterior and have posterior columns. The acetabulum is contained between these two columns, as they meet in the shape of an inverted Y in the innominate bone.

The anterior column, which consists of the iliac wing and pelvic brim, extends to the pubic symphysis and contains the anterior one half of the acetabular articular surface. Read more

Complications of Pelvic Fractures

Apart from excessive  bleeding that results from the injury there are many other complications of pelvic fracture which can be directly related injury or as an indirect result. There are other complications which may be related to the treatment.

Complications related To Treatment

Most complications of extenral fixation are the result of pin loosening or infection, and inadequacies of the reduction and fixation. Improper insertion and location of fixation pins in the ilium usually results in early loss of fixation. This leads to pain, loss of reduction, and pin-track infection. Read more

Pelvic Fractures-Clinical and Radiograhic Assessment

Before treating pelvic disruption it is prudent to characterize the injury by its clinical and radiologic features.Clinical and Radiographic assessment of the pelvic fracture victim. Patient should be cilnically examined to look for open wounds, deformities, neurovascular assessment, and uogenital and rectal injury

Radiologic evaluation is carried out by plain xrays (anteroposterior, inlet, outlet, Judet views), computed tomography, fluoroscopy and stress views. In case of need specialized imaging like 3D CT, angiogram, magnetic resonance imaging can be done. Read more

Madelung Deformity

Madelung’s deformity is a congenital abnormality of the wrist caused by a growth disturbance that retards development of the ulnar and volar portions of the distal radial physis.

The eponym gives credit to Madelung, who described this entity. Carpus curvus, radius curvus, and progressive subluxation of the wrist, manus valgus, and manus furca are other terms used for this condition.

The primary deformity is bowing of the distal end of the radius, which in the most typical form curves in a volar diorection while the ulna continues to grow in a straight line. The distal ends of the radius and ulna are at different levels in the lateral plane. That of the ulna has maintained its original normal position, while that of the radius has curved down to a volar level. Read more

Pelvic Fractures-An Outline of Management of Urologic Injury

A Foley’s Catheter is routinely used to document urinary output as a crucial determinant of adequate volume resuscitation in trauma.

In the presence of a major pelvic fracture, urinary catheterization requires special requires special consideration.

The incidence of concomitant injury to the bladder or urethra is about 20 percent.

if there is any suspicion of a urethral injury in male patients, it is advisable to obtain a urethrogram because Attempts to pass a catheter blindly through a partially disrupted male urethra can aggravate a partial tear and result in a stricture, incontinence, or impotence.

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Mechanisms of Injury to the Pelvic Ring

Injury patterns correlate with the vector of the provocative blow. The force vectors and pelvic injury patterns also correlate with the anticipated patterns of additional injuries to the abdomen, intrapelvic contents, chest, and head, as well as with the potential for significant hemorrhage. Read more

Pelvic Fracture-Asessment, Emergency Management and Definitive Treatment

In history of substantial trauma of any form, whether it is motor vehicular accident or fall from height should always alert the physician or health worker to rule out all life threatening conditions. As per protocol patient is assessed for airway, breathing and circulation at the sit of accident.

A head to toe examination is carried out to look for any gross injury in any other part of body.

Pelvis is tested by direct palpation,Pelvic Compression and Distraction Tests.

In case of injury the pelvis would reveal tenderness. If compressssion or distraction tests are positive for pelvis, it indicates instability of the pelvis.

If there is an overt bleeding , a pressure bandage should be applied. Pelvis should be quickly and temporarily stabilized by wrapping sheet a tightly around it and securing it with a clamp. Read more

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