FRACTURE OF FRACTURE OF COLLUMNA COLLUMNA

VERTEBRALISVERTEBRALIS

Dr. JOHAN BASTIAN SpOTDr. JOHAN BASTIAN SpOT

Orthopaedic dan Traumatologi RSUD KANJURUHAN KEPANJEN

Since 2500 SM Since 2500 SM USA 1500 case/yearUSA 1500 case/year 50% road traffic accident, 50% road traffic accident,

40% fall from height, 40% fall from height,

10% sport injury10% sport injury

Vertebral Column : Vertebral Column :

7 cervical 7 cervical 12 thoracal 12 thoracal 5 lumbar 5 lumbar 5 sacrum and 5 5 sacrum and 5

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History History

Preinjury Neurologic StatusPreinjury Neurologic Status Mechanism of InjuryMechanism of Injury Changes in Neurologic StatusChanges in Neurologic Status DocumentDocument

Vertebral AssessmentVertebral Assessment PainPain Tenderness Tenderness DeformityDeformity Edema, ecchymosis Edema, ecchymosis Muscle SpasmMuscle Spasm Tracheal Deviation, Hematoma Tracheal Deviation, Hematoma

AssessmentAssessment Neutral position, totally immobilizedNeutral position, totally immobilized A,B,CA,B,C Injury maybe masked Injury maybe masked Roentgenogram Roentgenogram DocumentDocument Early neurosurgical orthopedic Early neurosurgical orthopedic

consultationconsultation

Spinal InjurySpinal Injury

Prevent further injuryPrevent further injury Presume present of injury until excludedPresume present of injury until excluded

ManagementManagement

Immobilized until excludedImmobilized until excluded Intravenous fluids Intravenous fluids diuretic, steroiddiuretic, steroid TransferTransfer

Immobilization with Collar Neck and Long Spine Board

ManagementManagement

Intravenous FluidsIntravenous Fluids Treat hypovolemia firstTreat hypovolemia first Consider neurogenic Consider neurogenic

shockshock Urinary catheterUrinary catheter

MedicatiMedication on

DiureticDiuretics s

SteroidSteroidss

consultOrthopedic

Surgeon

ManagementManagement

TransferTransfer After neurosurgical orthopedic consultAfter neurosurgical orthopedic consult Unstable fractureUnstable fracture Neurologic deficitNeurologic deficit Avoid delayAvoid delay Properly immobilizedProperly immobilized Respiratory support as neededRespiratory support as needed

ManagementManagement

Suspect Cervical Spine InjurySuspect Cervical Spine Injury

supraclavicular injurysupraclavicular injury Head injury with/without loss Head injury with/without loss

of consciousnessof consciousness

X-RAY INVESTIGATIONX-RAY INVESTIGATION

Open mouth viewOpen mouth view Swimmer’s Swimmer’s

Open Mouth ViewOpen Mouth View

Indication : Indication : – Neck pain / neck injury Neck pain / neck injury suspect fractur suspect fractur

Evaluated :Evaluated :– OdontoidOdontoid– Lateralis mass C1 dan C2 Lateralis mass C1 dan C2

Open Mouth ViewOpen Mouth View

Open Mouth ViewOpen Mouth View

Swimmer’s ViewSwimmer’s View

Swimmer’s ViewSwimmer’s View

Radiographic Radiographic GuidelinesGuidelines

AP diameter of canalAP diameter of canal Contour/alignment vertebraContour/alignment vertebra Bone fragment displacementBone fragment displacement FractureFracture Soft – tissue swellingSoft – tissue swelling

Lateral C-spine film

Adequate C-spine filmAdequate C-spine filmInadequate C-spine film

Cervical Cervical SStrain (whiplash)train (whiplash)

Soft tissue injury due to sudden Soft tissue injury due to sudden hyperextension hyperextension

Anterior longitudinal ligament and iv Anterior longitudinal ligament and iv disc teardisc tear

Atlas Fracture (C1)Atlas Fracture (C1)

Involve a blow out of the ring Involve a blow out of the ring C1 ---> fracture JeffersonC1 ---> fracture Jefferson

Seen best on open mouth view Seen best on open mouth view of C1 and C2 areaof C1 and C2 area

Bilateral Jefferson Bilateral Jefferson fracture (C-1 fracture (C-1 Atlas)Atlas)

Axis Fracture (C2)Axis Fracture (C2)

Odontoid Fracture Odontoid Fracture – Above the base of adontoid (type 1), at Above the base of adontoid (type 1), at

the base (type 2) and extends into the the base (type 2) and extends into the vertebral body (type 3). vertebral body (type 3).

posterior element fracture of C2 posterior element fracture of C2 ---> the fracture Hangman ---> the fracture Hangman

Hangman’s fractureHangman’s fracture

Fracture Dislocation C3 - Fracture Dislocation C3 - C7C7 Mechanism of injury; flexion axial Mechanism of injury; flexion axial

loading, extension axial loading, or loading, extension axial loading, or flexion rotation injuryflexion rotation injury

Level C5 Level C5 most common site of most common site of fracture fracture

C5-C6 C5-C6 most common dislocation most common dislocation

Suspect Spine InjurySuspect Spine Injury cervical, thoracal, lumbarcervical, thoracal, lumbar

High speed crashHigh speed crash Multiple traumaMultiple trauma

Symmetry of pedicleSymmetry of pedicle Height of the disc spacesHeight of the disc spaces Alignment of. spinous ProcAlignment of. spinous Proc Shape/contour of vertebral Shape/contour of vertebral

bodiesbodies

Thoracic and lumbar spine

Radiographic Radiographic GuidelinesGuidelines

Vertebral Thoracal Vertebral Thoracal Fracture Fracture Mechanism of injury; wedge Mechanism of injury; wedge

compression, burst fracture, compression, burst fracture, fracture dislocationfracture dislocation

Stable and unstableStable and unstable Cause by fall from heightCause by fall from height

Vertebral Lumbar FractureVertebral Lumbar Fracture

More mobility than thoracal More mobility than thoracal vertebravertebra

Trauma Jack-knife ---> seat belt Trauma Jack-knife ---> seat belt injury ---> injury ---> Chance FractureChance Fracture

RO Thoracal (AP)

RO Thoracal (Lateral)

RO Thoracal (Lateral)

RO Thoracolumbal (AP)

RO Thoracolumbal (Lateral)

RO Lumbal (AP)

RO Lumbal (Lateral)

Lumbal X-Ray

AP Lateral

Wedge compression fractureWedge compression fracture

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