Bogomolets National Medical University MD, prof. Burianov O.A.

1. MD, prof. Burianov O.A.
Injuries of the spine and pelvis

2. Reasons for pelvic injuries:
Road accident
Catatrauma
Lethality at
fractures of the pelvis
is
5-35.8%
(John T., 2005)

3. Bone ring formed by two iliac bones, sacrum and coccyx.
The main ligaments that bind bone structures:
sacroiliac (anterior, posterior and interosseous),
sacroiliac, sacroiliac, sacrospinous

4. Classification of pelvic injuries by AO / ASI
"Stability - instability"
continuity - the continuity of the pelvic ring and the state of the ligaments of the
sacroiliac joints.
Type A includes stable injuries without violating the continuity of the pelvic ring
Type B - rotational-unstable injuries.With a violation of the continuity of the
anterior or posterior pelvic ring.
To type C (the most difficult) - vertically - unstable damages.With a violation of
the continuity of the anterior and posterior pelvic ring.

6. Type A
stable
Marginal fractures of the iliac
wing, upper or lower spine,
the edge of the sciatic
hump, the edge of the
sacrum and coccyx

8. Type В
Rotationally unstable
Ruptures of the pubic
symphysis or fractures
of the anterior pelvis
of the "open book"
type + rupture of the
ventral sacroiliac
ligaments,
damage to both
sacroiliac joints.

12. Type C Vertically unstable
A combination of
vertically rotational
unstable injury on one
side of the pelvis and
rotational unstable injury
on the other, bilateral
vertically rotational
unstable pelvic injuries.

16. Werneil's symptom Larrey's symptom
Comparative measurement of pelvic halves

17. Traumatic shock
30% -in unstable pelvic fractures
100% - with pelvic fractures + fractures of large
segments of the musculoskeletal system + damage
to internal organs
The patient's life depends on the
duration and scope of treatment at all
stages of medical care
Mortality is 73.27% in the first 3 days.
.

18. Stage Systolic
BP
Volume of
blood loss
Algover’s
Index
HR/SPB
Consciousness
I 90 До1 0,8-1 +
II 70-90 1 – 1,5 1,1-1,5 +
III 50-70 1,5-2 1,6 + - (sopor)
IV terminal -
Traumatic shock

19. Type A No shock, little blood loss
Factors in the development of
shock are:
concomitant multiple,
combined and combined
injuries, blood loss,
pain factor;
late and inadequate first aid.
Type B, C (about 31% traumatic shock)

20. The adequacy of anti-shock treatment
depends on:
from the timeliness of treatment (at the
scene, transportation)
from the speed of hospitalization - during
the first ("golden") hour from the moment
of injury.

21. Treatment of traumatic shock:
1.Stop bleeding
2. Ensuring airway patency (airway, laryngeal mask)
3. Artificial lung ventilation
4. Catheterization of peripheral veins
5. Restoration of cardiac activity (hydrocortisone,
epinephrine, norepinephrine).
6. Anesthesia
7. Restoration of BCC (transfusion of warm solutions),
8. Warming up the victim
9. Immobilization of the cervical spine.

22. Treatment of traumatic shock:
10. Immobilization of both halves of the pelvis by corset
fixation (hammock), frame-pneumatic orthosis
11. The correct position of the patient - on a semi-soft
surface of the burden in a semi-sitting position with
moderately bent in the hip joints of the lower
extremities, with fixation of the latter and the torso.
12. Pelvic anesthesia according to Selivanov-
Shkolnikov.

23. Anti-shock pelvic splint
Army anti-shock
pants MAST

24. In the admission department (surgeon, traumatologist, neurosurgeon, resuscitator, urologist and
others).
• In the anti-shock ward of the department the resuscitator provides:
• monitoring of vital functions, adequacy of external respiration
• (if necessary, conducts tracheal intubation, mechanical ventilation)
• ECG
• the next laboratory assistant takes a general blood test to determine hematocrit and sugar.
• correction of infusion therapy - intravenous injection depending on the degree of shock
• 500 ml of warm physiological saline, 500 ml of solution, hydroxyethyl starch (voluven,
KhNPP-sterile, gecodesis) or 250 ml of hyperHNPP are introduced,
• 4 ml of dicynon, 10 ml of calcium chloride
• 250 mg of hydrocortisone.
• catheterization of the bladder is performed.

25. Examination: multislice computed tomography of the pelvis
and other damaged areas of the body (MS CT)
or radiography of the pelvis and damaged segments of the
body, chest.
Ultrasound of the parenchymal organs of the abdominal
cavity and retroperitoneal space.
In the intensive care unit for a full range of
intensive care.
NB. MRI and CT of the brain are performed
only after stabilization of the general condition
of the patient.
Type A (stable) Type B/C (unstable)
In traumatological department

26. After resuscitation:
First turn:
urgent medical and diagnostic surgical interventions:
thoracentesis, laparocentesis. In cases of intra-abdominal
bleeding, laparotomy and hemostasis are performed.
Unstable pelvic injuries of one-moment repositioning of the
pelvic halves and fixation of the pelvis by means of a Hanz frame
or external fixation devices (Extrafocal apparatus).

27. At the second stage of treatment after correction of the
general condition of the patient of operation:
osteosynthesis of bones of large segments, mainly by
external fixation devices,
blocking intramedullary rods (nailing)
to ensure the conditions of adequate bed rest, prevention
of hypodynamic disorders due to the forced position of
the patient, which is important for the prevention of
complications.

28. At the third stage (the average term of the third
stage is 12-14 days) the final traumatological
correction of the pelvic fracture is performed by
open repositioning and internal fixation with
shaped plates and screws.

29. Percutaneous fixation of the
sacroiliac joint with screws

30. Fracture type C-1: osteosynthesis

31. Hanging in a hammock
Options for conservative treatment
of unstable pelvic fractures:

32. Beller tires, Volkovich position, skeletal traction
Options for conservative treatment of
unstable pelvic fractures:

33. Fractures of the acetabulum of the pelvis.
Classification:
fractures of the posterior edge or roof of the
acetabulum without dislocation
fractures of the posterior edge or roof of the
acetabulum with dislocation of the femur;
fracture of the bottom of the acetabulum with
central dislocation of the femur;
horizontal fracture of the iliac bone at the level of
the acetabulum.

35. Transverse fracture

36. Transverse and fracture of the
posterior wall

37. Central hip dislocation

38. Fracture of the
posterior wall of
the acetabulum:
osteosynthesis

39. Two-column fracture of the acetabulum
and iliac wings

40. Injuries of vertebral
column (spine)

41. There are two support complexes in the spine - anterior and
posterior.

42. Stable and unstable
Unstable - damage to the posterior fixation
complex (arches, arcuate joints, spinous and
transverse processes) and ligaments.
There is a tendency to displace the vertebrae
with the threat of compression of the
neurovascular formations of the spinal canal.

43. Uncomplicated and complicated.
Complicated injuries - damage to the
structures of the spine is complicated by
damage to the spinal cord, its roots,
ponytail.

44. Damage by the nature of the violation of the structures
of the spine
1. Damage to the communication device
2. Fractures of vertebral bodies
3. Damage to the intervertebral discs with rupture of
the fibrous ring and displacement of the pulpal
nucleus.
4. Fractures of the posterior half-ring of the vertebrae
(arches, joints, transverse or spinous processes).
5. Subluxations, dislocations and fractures-dislocations
of vertebrae
6.Traumatic spondylolisthesis.

45. Vertebral fractures can be stable
Cervical spine

46. Vertebral fractures can be unstable.
Cervical spine

47. X-ray examination of the cervical spine is performed in
two projections: anterior-posterior and lateral
Dislocations in the atlanto-occipital joint.

48. Cervical spine
fracture of the C2 dentate process (axis)

49. Conservative treatment of stable injuries
At unstable fractures in cervical department of a backbone and in case of
deformation of the channel of a backbone operative treatment
anterior corporodesis - open reposition from the anterior access with fixation of
the damaged segment of the spine by bone autografts.

50. Trauma to the thoracic and lumbar spine
the main mechanism of action of forces on the
spine -
compression (A),
stretching (B)
rotational - axial torsion (C).
The vertebrae are most often damaged
in the most motor part of the spine
- from X thoracic to III lumbar.

51. The most informative
computed tomography,
MRI
which make it possible to obtain accurate information
about the condition of all structures of the examined
vertebra, spinal canal and disc.

52. Fractures of the thoracic spine.

53. Treatment of stable fractures of the thoracic
spine
Functional method - on the recliner

54. Functional method of treatment of compression
fractures of the vertebrae, proposed by Gorynevskaya
and Dreving (1932).
In the first period (2 - 10th day) reach the maximum reclination of the spine and
prescribe therapeutic gymnastics of a general hygienic nature and exercises
for the upper extremities and feet.
The second period begins on the 10th and lasts until the 25th day. In addition to general
hygienic exercises in this period appoint active movements of the upper extremities with a
gradual connection to the active movements of the lower extremities, back muscles by lifting
the pelvis, torso, exercises in the supine position. Assign massage of the upper and lower
extremities.
The third period is the 25th-60th day after the injury. In addition to the exercises of the second
period, intensive exercises are prescribed to strengthen the muscles of the back and
abdomen. Under no circumstances should torso flexion exercises be prescribed. Patients
raise the torso and pelvis, resting on elbows and knees, crawl on the bed. Prescribe back
muscle massage.
The fourth period covers 60-90 days after injury. The victims continue to perform the exercises
of the third period, as well as learn to get out of bed, then - to walk, maintaining a posture, and
gradually increase the time spent on their feet, join an active social life.

55. Complicated closed spinal injuries:
• Concussion of the spinal cord
• Spinal cord injury
• Compression of the spinal cord

56. Emergency medical care:
Careful release of the victim from under blockages, cars, etc.
Immobilization of the cervical spine with a rigid splint, orthosis
(Kendrick) - complete, reliable - immobilization on the principle of
"only 1 time".
Resumption of respiration (if necessary, carefully - air duct).
Methylprednisolone 30 mg / kg is administered intravenously for
the first 8 hours, then 15 mg / kg every 6 hours, then 5 mg / kg
every 48 hours for 48 hours.
Correction of bradycardia, low blood pressure: atropine sulfate,
dopamine, rheopolyglucin, polyglucin, hypertonic (3-7%) NaCl
solution - BCC recovery.

57. Emergency medical care:
6. Simultaneous transfer of the patient - on the principle of
"head-neck-chest - a single whole" on a semi-rigid stretcher with
a roller placed under the knees and fixation of the victim.
7. Hospitalization in a horizontal position.
8. Furosemidum 40mg. intravenously or intravenously, piracetam
5.0 intravenously, cerebrolysin 15-30 ml intravenously, vitamin E.
5 ml intravenously, diphenine 500 mg intravenously, analgesics,
sedatives
9. Return of the patient every 2 hours.
10. Catheterization of the bladder
11. Ventilation through a mask.
12. Hospitalization in the neurosurgical department.