Orthopedic Care and Consultation
Follwing xrays are of thoracolumbar spine of patient with spinal injury. The patient has fracture of D12 vertebra and dislocation of D11 over D12 vertebra.
Here is the AP view
Fracture of D12 Vertebra With Dislocation of D11-D12 AP View
Here is lateral view [Read more...]
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.
Atlas fractures can be stable or unstable injuries. This fracture has very high association with injuries to other areas of the spine.
A fracture of atlas vertebra should cause enough alert to search for injuries in other region of the spine.
Almost 43% of all C-1 fractures are found to be associated with a C-2 fracture.
Atlas fractures have been divided into following 5 types. [Read more...]
After initial care of the patient with spinal injury, decision is made about the definitive care. A definitive care aims at making the injured spine stable and removing any decompression on the spinal cord.
Because not all patients would have neural injury and not all patients would have instability of the spine, the definitive treatment has a spectrum from immobilization with a collar to surgery. There are indications for each method and one treatment cannot treat all kind of injuries.
Following are the ways of treating a spinal injury
The rate for missed or delayed diagnosis of cervical spine injury is 1-4%. The most frequent reasons for missed injuries are inadequate assessment, inadequate radiographs and misinterpretation of radiographs. Patients who deteriorate from a missed injury may have severe complication like death, quadriplegia other new neurologic deficits.
Therefore, a potential spinal injury should be assumed and the patient protected should be protected unless declared free of spinal injury or definitive treatment is provided. it has been found that neurologic deterioration after admission occurs in 5% of spine injury patients and most of it can be prevented if precautions are observed.
Spine clearance is a combination of clinical patient assessment and radiographic evaluation . [Read more...]
After initial examination , complete spine examination and neurological assessment follows resuscitation. This detailed assessment begins with review of reports from the field.
This detail examination follows a different sequence in unresponsive and awake (cooperative) patients and and awake sequence of evaluation and intervention steps differs in unresponsive patients from awake and cooperative patients.
History
If patient is responsive, a detailed history is obtained regarding acute symptoms and past history.
For unresponsive patients, a past history is obtained from family members or available previous medical records. [Read more...]
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