Axial skeleton trauma

51 Axial skeleton trauma





Questions



image How would you manage a suspected spinal injury?

image How do you interpret a cervical spine radiograph?

image What is the initial management of a pelvic fracture?

All patients who have suffered trauma must be first assessed by the ABC principles including immobilization of the cervical spine and resuscitation for shock. Life-threatening injuries are treated first.


The axial skeleton comprises the skull (see Ch. 72) and spine, and it is also useful to consider the pelvis here. Trauma victims are always initially assessed by ABC principles including immobilization of the cervical spine and treatment of shock.



image SPINAL TRAUMA AND VERTEBRAL FRACTURES


Most spinal injuries occur in accidents, primarily RTAs (50%), accidents in the home and workplace, or sports injuries. Cord injury is only seen in 5%. All unconscious patients should be assumed to have a spinal injury; a fractured vertebra is unstable until proved otherwise. A urinary catheter can be passed since the patient may lose filling reflexes with lower spinal injuries and go into painless urinary retention. Clearing the cervical spine is done with a combination of clinical, neurological and radiographical examinations. Radiographs include a lateral radiograph to show the first cervical to first thoracic vertebrae (C1 to C7/T1 junction; if it does not do this it is deemed inadequate) (Fig.3.51.1) and A-P views of the cervical spine and through the open mouth to show the odontoid peg (peg view). The radiographs are assessed using the ABCS system:


image adequacy: from C1–C7/T1 junction must be visible

image alignment of vertical contours formed from the vertebral bodies, spinal canal and spinous processes: a step of > 25% suggests a unifacet joint dislocation, and > 50% suggests a bifacet dislocation

image bone margin and density: outline of vertebral bodies and spinous processes for avulsion and wedge fractures

image cartilage and joints: odontoid peg fracture or dislocation

image soft tissues: disc spaces (prolapse may cause spinal cord compression) and soft tissue swelling.

image

Fig. 3.51.1 A lateral cervical spine radiograph from a patient involved in a RTA. There is a fracture of the C5 vertebral body, caused by a hyperextension injury. This is an inadequate film as C7 and T1 are not visible and there could be fracture or dislocation that is missed. (The film must be repeated to include the C7–T1 junction or a CT scan obtained.)



Management of a vertebral fracture


Stable fractures generally require immobilization. Unstable fractures are reduced with traction and then external fixation or surgical stabilization.


Cervical fractures:


image atlas (C1): disruption of the bony ring may become unstable; treatment is with halo-ring or surgical fusion
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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Axial skeleton trauma

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