Spinal cord injuries are commonly caused by motor vehicle accidents, falls, and sports. The cervical spine is most commonly injured, especially between C5-C6. Plain films and advanced imaging can help evaluate injuries. Flexion injuries risk paralysis and require stabilization to prevent further injury. Compression fractures are generally stable with rest, while burst fractures may require surgery if unstable.
1. Spinal cord injuries are commonly caused by motor vehicle accidents, falls, and sports. The cervical spine is most frequently injured.
2. Initial evaluation involves stabilizing the patient with a cervical collar and assessing for neurological deficits. Imaging such as X-rays and CT/MRI are used to classify fractures and guide treatment.
3. Treatment depends on the fracture type but may involve halo immobilization, surgery to stabilize fractures or decompress the spinal cord, or bracing for stable injuries. The goal is to restore spinal alignment and prevent further neurological injury.
The document discusses fractures of the clavicle bone. It covers the epidemiology, anatomy, mechanisms of injury, classifications, and treatment options for clavicle fractures. Clavicle fractures are common injuries that make up 5-10% of all fractures. The majority heal without surgery. There is debate around indications for early surgical treatment of certain displaced or unstable fractures. Treatment depends on the location and severity of the fracture.
Fracture and dislocation of the shoulder girdleomar ababneh
The document discusses anatomy, mechanism of injury, classification, diagnosis, and management of anterior shoulder dislocations. Key points include:
- Anterior shoulder dislocations are caused by an anteriorly directed force on the arm when abducted and externally rotated, which can tear the anterior labrum and ligaments.
- Associated injuries may include bone fractures like bony Bankart lesions or Hill-Sachs defects. Labral injuries include Bankart lesions in 80-90% of cases.
- Treatment depends on any associated injuries and classification. Most cases are treated non-operatively with sling immobilization followed by physical therapy. Surgery is required for repair of labral tears or bone defects.
This document provides information on cervical spine trauma. It discusses:
- Common levels of cervical spine injury being C2, C6, and C7.
- Classification systems for fractures of the atlas, dens fractures, and subaxial cervical fractures.
- Treatment approaches depending on the fracture type, including non-operative treatment with collars or halos and surgical stabilization with techniques like anterior or posterior fusion.
- Key anatomy and biomechanics relating to mechanisms of injury for various fracture patterns.
The document discusses cervical spine anatomy and imaging of cervical spine injuries. It describes the unique characteristics of C1 and C2 vertebrae including their articular surfaces and ligaments. Common cervical spine fractures are described such as flexion teardrop fractures, wedge fractures, hangman's fractures, and odontoid fractures. Imaging views useful for evaluating cervical spine injuries are outlined including lateral, AP, odontoid, and swimmer's views. Findings suggestive of injuries on these views are provided.
Atlantoaxial injuries can cause serious neurologic problems if not properly treated. Rotatory subluxation of C1 on C2 is the most common type and results from trauma or infection that disrupts the transverse atlantal ligament. Anterior subluxation involves displacement of C1 forward on C2 due to ligament disruption or odontoid process abnormalities. Fractures of C1 and C2 can also occur from trauma and require evaluation to assess stability and neurologic involvement. Treatment depends on the specific injury but may involve traction, immobilization, or fusion surgery to prevent further neurologic damage.
1. Clavicle fractures most commonly occur in the midshaft region, resulting from a direct blow to the shoulder.
2. Physical examination reveals swelling, bruising, and deformity at the fracture site. X-rays are usually sufficient to diagnose the fracture.
3. Displaced midshaft fractures are often treated surgically using plates or intramedullary pins to restore length and alignment. Post-operatively, patients begin range of motion exercises and are weaned from immobilization over several weeks.
1. Spinal cord injuries are commonly caused by motor vehicle accidents, falls, and sports. The cervical spine is most frequently injured.
2. Initial evaluation involves stabilizing the patient with a cervical collar and assessing for neurological deficits. Imaging such as X-rays and CT/MRI are used to classify fractures and guide treatment.
3. Treatment depends on the fracture type but may involve halo immobilization, surgery to stabilize fractures or decompress the spinal cord, or bracing for stable injuries. The goal is to restore spinal alignment and prevent further neurological injury.
The document discusses fractures of the clavicle bone. It covers the epidemiology, anatomy, mechanisms of injury, classifications, and treatment options for clavicle fractures. Clavicle fractures are common injuries that make up 5-10% of all fractures. The majority heal without surgery. There is debate around indications for early surgical treatment of certain displaced or unstable fractures. Treatment depends on the location and severity of the fracture.
Fracture and dislocation of the shoulder girdleomar ababneh
The document discusses anatomy, mechanism of injury, classification, diagnosis, and management of anterior shoulder dislocations. Key points include:
- Anterior shoulder dislocations are caused by an anteriorly directed force on the arm when abducted and externally rotated, which can tear the anterior labrum and ligaments.
- Associated injuries may include bone fractures like bony Bankart lesions or Hill-Sachs defects. Labral injuries include Bankart lesions in 80-90% of cases.
- Treatment depends on any associated injuries and classification. Most cases are treated non-operatively with sling immobilization followed by physical therapy. Surgery is required for repair of labral tears or bone defects.
This document provides information on cervical spine trauma. It discusses:
- Common levels of cervical spine injury being C2, C6, and C7.
- Classification systems for fractures of the atlas, dens fractures, and subaxial cervical fractures.
- Treatment approaches depending on the fracture type, including non-operative treatment with collars or halos and surgical stabilization with techniques like anterior or posterior fusion.
- Key anatomy and biomechanics relating to mechanisms of injury for various fracture patterns.
The document discusses cervical spine anatomy and imaging of cervical spine injuries. It describes the unique characteristics of C1 and C2 vertebrae including their articular surfaces and ligaments. Common cervical spine fractures are described such as flexion teardrop fractures, wedge fractures, hangman's fractures, and odontoid fractures. Imaging views useful for evaluating cervical spine injuries are outlined including lateral, AP, odontoid, and swimmer's views. Findings suggestive of injuries on these views are provided.
Atlantoaxial injuries can cause serious neurologic problems if not properly treated. Rotatory subluxation of C1 on C2 is the most common type and results from trauma or infection that disrupts the transverse atlantal ligament. Anterior subluxation involves displacement of C1 forward on C2 due to ligament disruption or odontoid process abnormalities. Fractures of C1 and C2 can also occur from trauma and require evaluation to assess stability and neurologic involvement. Treatment depends on the specific injury but may involve traction, immobilization, or fusion surgery to prevent further neurologic damage.
1. Clavicle fractures most commonly occur in the midshaft region, resulting from a direct blow to the shoulder.
2. Physical examination reveals swelling, bruising, and deformity at the fracture site. X-rays are usually sufficient to diagnose the fracture.
3. Displaced midshaft fractures are often treated surgically using plates or intramedullary pins to restore length and alignment. Post-operatively, patients begin range of motion exercises and are weaned from immobilization over several weeks.
paediatric injuries around the elbow
supracondylar elbow injuries
pulled elbow in paediatric age r
radiological signs around elbow in supracondylar fracture humerus
The cervical spine anatomy is specialized to support the cranium while allowing a large range of motion. C1 (atlas) has no vertebral body and unique articular pillars. C2 (axis) has a dens that is embryologically derived from C1's body. The ligaments of the cervical spine, including the tectorial membrane and transverse ligament, allow for wide range of motion while maintaining stability. Common cervical spine injuries include flexion teardrop fractures from hyperflexion, wedge fractures from compression, hangman's fractures from hyperextension, and Jefferson fractures from axial loading. Odontoid fractures also occur from hyperextension or hyperflexion forces on the neck. Radiographic evaluation of
C2 fractures can range from asymptomatic to paralysis and are often caused by motor vehicle accidents or falls. Higher level cervical spine injuries carry greater risks. C2 fractures include odontoid fractures, lateral mass fractures, extension teardrop fractures, and traumatic spondylolisthesis (hangman's fracture). Diagnosis involves imaging like X-rays and CT/MRI to classify the fracture. Treatment depends on fracture type and severity but may include immobilization, traction, internal fixation, or fusion surgery. Complications can include malunion, nonunion, or pseudarthrosis if not properly treated.
1) The document discusses injuries at the occipitocervical junction, including classifications of various injuries such as atlanto-occipital dissociation, transverse ligament injuries, rotatory C1-C2 subluxations, and fractures of the occipital condyle, C1, and C2.
2) Evaluation involves imaging such as CT, which is more sensitive than radiographs, to assess injuries and instability based on measurements. Management depends on the specific injury but may include immobilization in a collar, halo vest, or surgery such as occipitocervical fusion.
3) Occipitocervical fusion techniques are described, including use of rods, cables,
A spinal cord injury can result in permanent impairment if not properly diagnosed and managed. The document defines spinal cord injury and discusses epidemiology, anatomy, pathophysiology, and management. It describes the structure and blood supply of the spine, classification systems for fractures, and associated conditions like spinal and neurogenic shock. Key tracts and myotomes are also outlined.
Osteosynthesis a physiological way of managing Hangman’s fractureApollo Hospitals
Most of the Hangman’s fractures are treated conservatively. Surgical indication is only in type IIA and III fractures. There are many ways of fixing fractured spine either by anterior or posterior. Osteosynthesis of C2 pedicle by transpedicular screw in type IIA is a newer concept started by Judet by putting appropriate length of screws in C2 pedicle, so the fracture reduces and anatomical motion will remain intact. In fact it is a more physiological concept of fixing.
Common lower limb injuries include fractures, dislocations, and subluxations of bones or joints. Posterior hip dislocations are the most common type of hip dislocation, often caused by an axial load on the flexed and adducted hip. They are diagnosed via x-ray and treated initially with closed reduction and immobilization. Complications can include avascular necrosis, stiffness, and late onset osteoarthritis. Femoral neck fractures are also common in the elderly and are classified using the Garden system to determine appropriate treatment.
Evaluation of Spinal Injury & Emergency ManagementAtif Shahzad
This document provides information on spinal injuries, including:
- Traumatic spinal cord injuries result in 12,000 new cases per year in the US. Most injuries occur in men aged 16-30 from vehicle crashes, falls, or sports.
- Injuries are categorized by location (cervical, thoracic, lumbar), stability (stable or unstable), and neurological status (complete or incomplete paralysis).
- Initial treatment follows ATLS protocols to stabilize the spine and assess airway, breathing, circulation, disability, and exposure. Advanced imaging can further evaluate bone and neurological injuries.
The document discusses injuries to the spine. It covers the epidemiology, anatomy, classification of injuries as stable or unstable, and mechanisms of injury. It then describes specific cervical and thoracolumbar spine injuries, including fractures, dislocations, and treatment approaches which may involve immobilization, traction, or surgery.
Fractures are breaks in bone continuity that can range from complete breaks to incomplete breaks. Globally in 2000, there were an estimated 9 million new fragility fractures, including over 1.6 million at the hip. Fractures are classified based on their anatomic features such as type, comminution, location, and displacement. Other classifications include the AO classification system for long bones, Salter-Harris classification for pediatric physeal fractures, and the Gustillo-Anderson classification for open fractures. Clinical presentation of fractures involves symptoms of pain, swelling, deformity, and loss of function as well as signs found on examination and imaging studies. Management principles involve stabilization, reduction, fixation, exercise, and physiotherapy.
This document provides information on cervical spine injuries, including:
- Upper cervical injuries involve C1-C2 and lower cervical injuries involve C3-C7.
- Common upper cervical injuries include fractures of the atlas and axis as well as occipital condyle fractures and occipitoatlantal dislocations.
- Lower cervical spine injuries include fractures of the vertebral bodies and posterior elements like the lamina.
- Detailed classifications and treatment recommendations are provided for various cervical fractures and dislocations. Imaging like CT and MRI play an important role in evaluation of these injuries.
(Orthopedics) Femoral neck fractures (Anatomy, pathophysiology and treatment ...Kalimullah Wardak
The document summarizes femoral neck fractures, including their anatomy, classification systems, causes, diagnosis, treatment, and complications. It describes how femoral neck fractures are classified based on their location (Garden classification) and angle (Pauwell's classification). Treatment involves closed or open reduction and internal fixation or arthroplasty. Younger patients often undergo internal fixation while older patients frequently receive hemiarthroplasty or total hip arthroplasty. Complications can include nonunion, avascular necrosis, and prolonged healing.
Fractures of the clavicle are common injuries, accounting for 2.6-4% of all fractures. In adults, clavicle fractures can be more problematic than in children. Displaced mid-shaft fractures, lateral-third fractures with coracoclavicular ligament disruption, and medial-third fractures threatening mediastinal structures often require surgical fixation, while minimally displaced fractures are usually treated non-operatively with slings or immobilization. Surgical techniques include plating, intramedullary fixation, coracoclavicular screws/plates, and hook plates. Complications can include non/malunion, shoulder stiffness, and for medial fractures, mediastinal injuries from implant migration
The document discusses fractures of the upper limb, specifically focusing on fractures of the elbow joint, radial head, and distal radius. It provides details on the anatomy, mechanisms of injury, classification systems, clinical presentation, treatment approaches, and potential complications for each type of fracture. For elbow fractures, closed and open reduction techniques are described for treating dislocations. Radial head fractures are classified using the Mason system and can be managed non-operatively or surgically with fixation or excision. Distal radius fractures commonly result from falls and involve the articular surfaces, with treatment depending on the degree of displacement.
The document summarizes anatomy and common injuries around the humerus and elbow joint. It discusses fractures of the humeral shaft, supracondylar fractures of the distal humerus in children, radial head and elbow dislocations. Management of these injuries includes closed reduction, splinting, casting or surgical fixation depending on the type and displacement of the fracture. Nerve injuries are common complications and must be monitored during treatment.
This document discusses various fractures and dislocations that can occur around the elbow joint. It begins with relevant elbow anatomy and then describes several types of fractures in detail, including supracondylar fractures, lateral condyle fractures, radial head fractures, and distal humerus fractures. It also discusses coronoid process fractures, radial head dislocations, Essex-Lopresti injuries (radial head fracture with distal radioulnar joint dislocation), and olecranon fractures. For each type of injury, it provides information on classification systems, mechanisms of injury, clinical features, imaging findings, and treatment approaches.
Orthopedic surgery 4th injuries to the upper limb ( 1 )RamiAboali
The document discusses injuries to the upper limb, including brachial plexus lesions and injuries, clavicle fractures, sternoclavicular joint injuries, acromioclavicular joint injuries, shoulder dislocations, and anterior shoulder dislocations specifically. It provides details on the mechanisms, classifications, clinical presentations, investigations, and management approaches for each of these orthopedic conditions.
The document discusses cervical spine injuries, including:
1. The cervical spine consists of 7 vertebrae that support the head and allow movement while protecting the spinal cord.
2. Cervical spine injuries commonly result from motor vehicle accidents, falls, sports, or assaults and can cause fractures, dislocations, or ligament damage in the upper or lower cervical spine.
3. Injuries are classified based on their location and mechanism, and treatment may involve immobilization, traction, surgery to stabilize and fuse vertebrae, or a combination depending on the severity and location of the injury. Precise imaging is important to diagnose injuries and guide appropriate treatment.
This document discusses shock in trauma and provides an overview of key topics including:
- The pathophysiology of shock involves inadequate oxygen delivery leading to cellular dysfunction.
- Hypovolemic shock from blood or fluid loss is a leading cause and requires rapid fluid resuscitation.
- A thorough physical exam and diagnostic tests are needed to identify the source of bleeding.
- Early intervention and resuscitation are important to reverse the effects of shock and reduce mortality.
This document provides an overview of evaluating orthopedic x-rays using the ABCs approach - Assessing Adequacy, Alignment, Bones, Cartilage, and Soft Tissues. It describes examining x-rays for the appropriate number of views and penetration, alignment of bones, any fractures or distortions of bones, widening of joint spaces, and soft tissue swelling. Examples are given of using this approach to identify fractures. Key terms for describing fractures such as open vs closed, location, fracture line, and relationship of fragments are also defined.
paediatric injuries around the elbow
supracondylar elbow injuries
pulled elbow in paediatric age r
radiological signs around elbow in supracondylar fracture humerus
The cervical spine anatomy is specialized to support the cranium while allowing a large range of motion. C1 (atlas) has no vertebral body and unique articular pillars. C2 (axis) has a dens that is embryologically derived from C1's body. The ligaments of the cervical spine, including the tectorial membrane and transverse ligament, allow for wide range of motion while maintaining stability. Common cervical spine injuries include flexion teardrop fractures from hyperflexion, wedge fractures from compression, hangman's fractures from hyperextension, and Jefferson fractures from axial loading. Odontoid fractures also occur from hyperextension or hyperflexion forces on the neck. Radiographic evaluation of
C2 fractures can range from asymptomatic to paralysis and are often caused by motor vehicle accidents or falls. Higher level cervical spine injuries carry greater risks. C2 fractures include odontoid fractures, lateral mass fractures, extension teardrop fractures, and traumatic spondylolisthesis (hangman's fracture). Diagnosis involves imaging like X-rays and CT/MRI to classify the fracture. Treatment depends on fracture type and severity but may include immobilization, traction, internal fixation, or fusion surgery. Complications can include malunion, nonunion, or pseudarthrosis if not properly treated.
1) The document discusses injuries at the occipitocervical junction, including classifications of various injuries such as atlanto-occipital dissociation, transverse ligament injuries, rotatory C1-C2 subluxations, and fractures of the occipital condyle, C1, and C2.
2) Evaluation involves imaging such as CT, which is more sensitive than radiographs, to assess injuries and instability based on measurements. Management depends on the specific injury but may include immobilization in a collar, halo vest, or surgery such as occipitocervical fusion.
3) Occipitocervical fusion techniques are described, including use of rods, cables,
A spinal cord injury can result in permanent impairment if not properly diagnosed and managed. The document defines spinal cord injury and discusses epidemiology, anatomy, pathophysiology, and management. It describes the structure and blood supply of the spine, classification systems for fractures, and associated conditions like spinal and neurogenic shock. Key tracts and myotomes are also outlined.
Osteosynthesis a physiological way of managing Hangman’s fractureApollo Hospitals
Most of the Hangman’s fractures are treated conservatively. Surgical indication is only in type IIA and III fractures. There are many ways of fixing fractured spine either by anterior or posterior. Osteosynthesis of C2 pedicle by transpedicular screw in type IIA is a newer concept started by Judet by putting appropriate length of screws in C2 pedicle, so the fracture reduces and anatomical motion will remain intact. In fact it is a more physiological concept of fixing.
Common lower limb injuries include fractures, dislocations, and subluxations of bones or joints. Posterior hip dislocations are the most common type of hip dislocation, often caused by an axial load on the flexed and adducted hip. They are diagnosed via x-ray and treated initially with closed reduction and immobilization. Complications can include avascular necrosis, stiffness, and late onset osteoarthritis. Femoral neck fractures are also common in the elderly and are classified using the Garden system to determine appropriate treatment.
Evaluation of Spinal Injury & Emergency ManagementAtif Shahzad
This document provides information on spinal injuries, including:
- Traumatic spinal cord injuries result in 12,000 new cases per year in the US. Most injuries occur in men aged 16-30 from vehicle crashes, falls, or sports.
- Injuries are categorized by location (cervical, thoracic, lumbar), stability (stable or unstable), and neurological status (complete or incomplete paralysis).
- Initial treatment follows ATLS protocols to stabilize the spine and assess airway, breathing, circulation, disability, and exposure. Advanced imaging can further evaluate bone and neurological injuries.
The document discusses injuries to the spine. It covers the epidemiology, anatomy, classification of injuries as stable or unstable, and mechanisms of injury. It then describes specific cervical and thoracolumbar spine injuries, including fractures, dislocations, and treatment approaches which may involve immobilization, traction, or surgery.
Fractures are breaks in bone continuity that can range from complete breaks to incomplete breaks. Globally in 2000, there were an estimated 9 million new fragility fractures, including over 1.6 million at the hip. Fractures are classified based on their anatomic features such as type, comminution, location, and displacement. Other classifications include the AO classification system for long bones, Salter-Harris classification for pediatric physeal fractures, and the Gustillo-Anderson classification for open fractures. Clinical presentation of fractures involves symptoms of pain, swelling, deformity, and loss of function as well as signs found on examination and imaging studies. Management principles involve stabilization, reduction, fixation, exercise, and physiotherapy.
This document provides information on cervical spine injuries, including:
- Upper cervical injuries involve C1-C2 and lower cervical injuries involve C3-C7.
- Common upper cervical injuries include fractures of the atlas and axis as well as occipital condyle fractures and occipitoatlantal dislocations.
- Lower cervical spine injuries include fractures of the vertebral bodies and posterior elements like the lamina.
- Detailed classifications and treatment recommendations are provided for various cervical fractures and dislocations. Imaging like CT and MRI play an important role in evaluation of these injuries.
(Orthopedics) Femoral neck fractures (Anatomy, pathophysiology and treatment ...Kalimullah Wardak
The document summarizes femoral neck fractures, including their anatomy, classification systems, causes, diagnosis, treatment, and complications. It describes how femoral neck fractures are classified based on their location (Garden classification) and angle (Pauwell's classification). Treatment involves closed or open reduction and internal fixation or arthroplasty. Younger patients often undergo internal fixation while older patients frequently receive hemiarthroplasty or total hip arthroplasty. Complications can include nonunion, avascular necrosis, and prolonged healing.
Fractures of the clavicle are common injuries, accounting for 2.6-4% of all fractures. In adults, clavicle fractures can be more problematic than in children. Displaced mid-shaft fractures, lateral-third fractures with coracoclavicular ligament disruption, and medial-third fractures threatening mediastinal structures often require surgical fixation, while minimally displaced fractures are usually treated non-operatively with slings or immobilization. Surgical techniques include plating, intramedullary fixation, coracoclavicular screws/plates, and hook plates. Complications can include non/malunion, shoulder stiffness, and for medial fractures, mediastinal injuries from implant migration
The document discusses fractures of the upper limb, specifically focusing on fractures of the elbow joint, radial head, and distal radius. It provides details on the anatomy, mechanisms of injury, classification systems, clinical presentation, treatment approaches, and potential complications for each type of fracture. For elbow fractures, closed and open reduction techniques are described for treating dislocations. Radial head fractures are classified using the Mason system and can be managed non-operatively or surgically with fixation or excision. Distal radius fractures commonly result from falls and involve the articular surfaces, with treatment depending on the degree of displacement.
The document summarizes anatomy and common injuries around the humerus and elbow joint. It discusses fractures of the humeral shaft, supracondylar fractures of the distal humerus in children, radial head and elbow dislocations. Management of these injuries includes closed reduction, splinting, casting or surgical fixation depending on the type and displacement of the fracture. Nerve injuries are common complications and must be monitored during treatment.
This document discusses various fractures and dislocations that can occur around the elbow joint. It begins with relevant elbow anatomy and then describes several types of fractures in detail, including supracondylar fractures, lateral condyle fractures, radial head fractures, and distal humerus fractures. It also discusses coronoid process fractures, radial head dislocations, Essex-Lopresti injuries (radial head fracture with distal radioulnar joint dislocation), and olecranon fractures. For each type of injury, it provides information on classification systems, mechanisms of injury, clinical features, imaging findings, and treatment approaches.
Orthopedic surgery 4th injuries to the upper limb ( 1 )RamiAboali
The document discusses injuries to the upper limb, including brachial plexus lesions and injuries, clavicle fractures, sternoclavicular joint injuries, acromioclavicular joint injuries, shoulder dislocations, and anterior shoulder dislocations specifically. It provides details on the mechanisms, classifications, clinical presentations, investigations, and management approaches for each of these orthopedic conditions.
The document discusses cervical spine injuries, including:
1. The cervical spine consists of 7 vertebrae that support the head and allow movement while protecting the spinal cord.
2. Cervical spine injuries commonly result from motor vehicle accidents, falls, sports, or assaults and can cause fractures, dislocations, or ligament damage in the upper or lower cervical spine.
3. Injuries are classified based on their location and mechanism, and treatment may involve immobilization, traction, surgery to stabilize and fuse vertebrae, or a combination depending on the severity and location of the injury. Precise imaging is important to diagnose injuries and guide appropriate treatment.
This document discusses shock in trauma and provides an overview of key topics including:
- The pathophysiology of shock involves inadequate oxygen delivery leading to cellular dysfunction.
- Hypovolemic shock from blood or fluid loss is a leading cause and requires rapid fluid resuscitation.
- A thorough physical exam and diagnostic tests are needed to identify the source of bleeding.
- Early intervention and resuscitation are important to reverse the effects of shock and reduce mortality.
This document provides an overview of evaluating orthopedic x-rays using the ABCs approach - Assessing Adequacy, Alignment, Bones, Cartilage, and Soft Tissues. It describes examining x-rays for the appropriate number of views and penetration, alignment of bones, any fractures or distortions of bones, widening of joint spaces, and soft tissue swelling. Examples are given of using this approach to identify fractures. Key terms for describing fractures such as open vs closed, location, fracture line, and relationship of fragments are also defined.
1) Trauma is a leading cause of non-obstetric mortality in pregnant patients. Common causes include motor vehicle accidents, domestic violence, falls, and penetrating injuries.
2) Pregnant patients experience many physiological changes including increased blood volume, cardiac output, and respiration that must be considered in their trauma management. Anatomical changes like uterine size and position can also impact injuries.
3) Diagnostic studies like ultrasound and CT scans are important for evaluation while minimizing radiation exposure to the fetus. Continuous fetal heart monitoring can identify non-reassuring signs. Surgical interventions may be needed for unstable mothers or fetuses.
A 28-year-old male was brought to the emergency room after a motor vehicle accident. He complained of chest pain, a forehead wound, and right forearm pain. Examination found he was conscious with stable vital signs. Chest x-ray revealed an abnormal aortic knob and widened mediastinum. CT angiogram confirmed a traumatic aortic tear. Despite treatment, his condition deteriorated with low blood pressure and increased pain. Aortography then definitively diagnosed aortic rupture, which requires urgent surgical repair for survival.
1- Initial Assessment and Management of the Trauma Patient.pptxAsgraf
The document provides an overview of the initial assessment and management of trauma patients, covering the primary and secondary surveys with a focus on evaluating airway, breathing, circulation, disability, and exposure/environment, as well as discussing specific injuries and treatments for conditions like tension pneumothorax, hemorrhagic shock, and cardiac tamponade.
The Glasgow Coma Scale (GCS) was developed to assess neurological function and brain injury severity. It evaluates eye opening, verbal response, and motor response on a scale of 3 to 15, with lower scores indicating more severe brain injury. The GCS is useful for prognosis, monitoring changes, and assessing the need for airway support. A modified Children's Coma Scale was also developed for those too young to communicate verbally.
This document provides guidance on trauma procedures for a patient presenting with a stab wound and signs of alcohol intoxication. It outlines steps for securing the airway with endotracheal intubation or cricothyroidotomy if needed. It also describes performing a tube thoracostomy for a hemopneumothorax, obtaining central venous access, arterial blood gas sampling, and placing a nasogastric tube. Key steps and considerations are outlined for each procedure along with potential complications. The document emphasizes the importance of practice to gain skill in lifesaving surgical procedures.
1) Chest trauma is predominantly caused by motor vehicle accidents and falls. The most common injuries are chest wall trauma and hemothorax.
2) Early deaths from chest trauma are often caused by airway obstruction, tension pneumothorax, massive hemothorax, or cardiac tamponade.
3) Initial assessment focuses on the ABCs with stabilization of life-threatening injuries like tension pneumothorax the top priority. Secondary surveys then identify and treat other injuries like simple pneumothorax, pulmonary contusion, and blunt cardiac injury.
The document discusses the initial assessment and management of pediatric trauma. It notes that while ABCDE priorities are the same as adults, children have unique anatomic and physiologic characteristics that require consideration, such as a larger head, softer bones, and narrower airway. It emphasizes the importance of recognizing potential abuse injuries and preventing injuries through strategies like bicycle helmet promotion.
Chest trauma can be life-threatening and accounts for 25% of all trauma deaths. It includes injuries from blunt forces like rib fractures or penetrating injuries from stab wounds. Without treatment, injuries can lead to hypoxia and hypotension from issues like pneumothorax, hemothorax, or flail chest. Proper management requires following ABC (airway, breathing, circulation) to ensure oxygen delivery and addressing specific injuries like tension pneumothorax through needle decompression or chest tube insertion.
FAST (Focused Assessment with Sonography in Trauma) is an ultrasound technique used to quickly detect the presence of free fluid in the abdomen or chest resulting from trauma. It can visualize fluid in seven dependent areas of the abdomen and the pericardial sac. FAST has sensitivity of 88-91.7% and specificity of 94.7-99% for detecting fluid. A positive FAST means fluid is detected in one of the areas scanned, while a negative FAST means no fluid is seen. FAST provides a rapid initial assessment and can help guide trauma management, but CT is more sensitive for characterizing injuries. Limitations include difficulty with obese patients, bowel gas, or retroperitoneal injuries.
The document provides an overview of the approach to musculoskeletal injuries in the emergency department. It discusses that musculoskeletal problems comprise approximately 11% of emergency department visits. The physician needs a systematic approach to orthopedic complaints that can range from minor sprains to life-threatening trauma. Commonly seen injuries include soft tissue injuries, fractures, dislocations, and infections. Less common but important injuries include spinal injuries, crush injuries, and compartment syndrome. The document then discusses fractures, pelvic fractures, long bone fractures, open fractures, deep venous thrombosis, crush injuries, compartment syndrome, and spinal injuries. It emphasizes the importance of thorough evaluation, splinting, consultation, and managing complications for these types of musculoskeletal emergencies.
This document discusses the medical management of acute coronary syndrome (ACS). It notes that over 4 million patients are admitted each year with unstable angina or acute myocardial infarction, and over 900,000 undergo percutaneous coronary intervention. ACS refers to a spectrum of conditions ranging from unstable angina to Q-wave and non-Q-wave myocardial infarction that are characterized by a disrupted atherosclerotic plaque. For treatment of unstable angina, the document recommends anticoagulant therapy with heparin or low-molecular weight heparin to reduce risks of myocardial infarction and death.
This document discusses acute coronary syndrome (ACS), including unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). It defines ACS and describes how the conditions are classified based on ECG and cardiac enzyme levels. It also discusses risk stratification in NSTEMI and typical management approaches for NSTEMI, UA, and STEMI. The document concludes with a case study describing a patient presenting with chest pain.
This document provides an overview of coronary artery disease, myocardial infarction, and related cardiac pharmacology. It discusses the etiology and risk factors of coronary artery disease, describes different types of angina pectoris, and outlines goals and medications for treating angina. It also covers atherosclerosis, statins, calcium channel blockers, beta blockers, ACE inhibitors, angiotensin receptor blockers, digoxin, and other cardiac medications. The document defines myocardial infarction and discusses gender differences, EKG changes, types, risks, effects, complications, diagnosis, and goals of treatment for MI.
The document provides an overview of burns, including epidemiology, classification, severity, treatment and complications. It notes that around 500,000 people in the US are treated annually for burns, which can be caused by heat, fires, scalding or chemicals. Burn extent is determined using the Rule of 9s or Lund & Browder chart and severity is classified from first to fourth degree burns based on depth of tissue damage. Treatment depends on severity but may include fluid resuscitation, wound care, surgery and infection prevention. Complications can include infection, respiratory distress and contractures.
The document discusses burn classifications and management. It describes the three main types of burns as thermal, chemical, and electrical. Thermal burns are the most common and caused by heat sources. Burn depth is classified as superficial, partial thickness, or full thickness. Initial burn management focuses on the ABCs - securing the airway, assessing breathing and circulation. Fluid resuscitation is crucial to prevent shock in large burns. Ongoing nursing care involves wound care, infection prevention and managing complications.
Care of the Burn Patient provides guidelines for treating burn injuries. It outlines conducting a primary and secondary survey to assess airway, breathing, circulation, disability, and exposure. This includes estimating burn size using the Rule of Nines or Lund & Browder chart for children. It also describes fluid resuscitation using the Parkland formula to replace fluid losses from capillary leakage in burned tissue. Proper burn management focuses on stopping the burning process, providing oxygen, intravenous fluids, pain control, and preventing infection.
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4. Epidemiology
the fourth leading cause of death in the US
C-spine injuries
MVAs - 50%
falls - 25%
sports activities - 10%
60% of all spine injuries in children;
upper cervical spine.
C5-C6 is the most commonly injured level in
adults.
6. Stability
Definition
1. The ability of the spine under physiologic
loads to prevent displacements which
would injure or irritate neural tissue.
2. Instability is the loss of the ability of the
spine to tolerate physiological loading
without incurring neurological deficit, pain,
or progre ssive structural deficit.
7. Initial evaluation and treatment
ABC's
Stablization for transport
don't move patient before stabilization of cervical
spine.
In hospital
Usual trauma protocol
Traction
rule of thumb is 5 pounds per spinal level above the
fracture/dislocation.
60-80 pounds are usually the upper limit in any case.
8. Pharmacologic treatment of SCI
1.Hypertension
adequate volume and normotension
2. Methylprednislone
within 8 hours of the SCI protocol
30mg/kg initial IV bolus over 15 minutes
followed by a 45 minute pause,
and then a 5.4 mg/kg/hr continuous infusion.
3. Naloxone
4. Triliazad
13. Inter-spinous process widening
(on AP radiographs)
More than 1.5 times the interspinous
distance at the levels above and below is
abnormal.
14. C1-C2 distance between posterior cortex of
C1 arch and odontoid is maximally 3 mm in
adults and 4.5 mm in children.
Normal spinal canal diameter is 17 ± 5 mm
Stenosis is present if <13 mm.
15. anterior subluxation of 3 mm of one body on
another (or >20% of the AP distance)
indicates instability.
angulation greater than 11° is suggestive of
instability.
16. Other Investigations
flexion and extension views, tomograms
CT, CT/myleogram, and MRI
MRI essential for suspected spinal cord injury
all soft tissues (disk and ligamentous
structures) are shown in much better detail.
18. Odontoid Anatomy
Steele's rule of thirds
The dens, subarachnoid space, and
spinal cord each occupy 1/3 of the area
of the canal at the level of the atlas.
22. Types of injuries
I. Atlanto-occipital dislocation.
II. Condylar fractures.
III. Atlanto-axial dislocation.
IV. Atlas fractures.
V. Odontoid fractures.
VI. Hangman's fractures.
VII. C3 fractures.
29. Classification
Type I An oblique fracture line through the upper part of the
odontoid process representing an avulsion
fracture where the alar ligaments attach. Stable,
high rate of fusion.
Type II A fracture at the junction between the odontoid
process and the body of the axis. Unstable, high
rate malunion.
Type IIA Similar to type II but with fragments of bone present
at the fracture site.
Type III A fracture that extends down into the cacellous bone
of the body of the axis and in reality is a fracture
of the body of C2. Stable, with high rate of fusion.
30. Epidemiology
about 10-15% of all cervical spine fractures.
In children, these consitute about 75% of all
C-spine injuries.
31. Clinical Features
need high index of suspicion in all trauma
patients
many signs and symptoms are non-specific
vertebral artery compression may cause brain
stem ischemic symptoms.
most patients unwilling to go from supine to
sitting position without supporting their heads
with their hands.
32. Imaging
open mouth views
tomography or CT
saggital and coronal
reconstructions
have superseded
tomography
33. Treatment and results
Halo traction, maximum of 5-10 pounds to
achieve reduction
Surgery
Type I : no fusion required
Type III : no fusion required
(>90% fuse with Halo immobilization)
Type II : several factors important in
decision making
34. 1. Patient age.
sixty years of age is the usually quoted cutoff
for conservative management.
2. Displacement
If >6 mm and >60 years, 85% nonunion rate.
3. Age of fracture
greater than 2 weeks seems to be the cutoff
for high union rate
35. Techniques for C1/C2 Fusion
C1/C2 fusions can
be considered even
if there is a
unilateral fracture of
the atlas ring, or
unilateral fracture of
the lateral mass of
the atlas.
36.
37. Hangman's Fracture
When submental knots with a measured
corporal drop are used to hang someone, a
classic hangman's C2 fracture is the result.
Pathophysiology and Classification
Hangman's fracture involves a bilateral arch
fracture of C2 (pars interarticularis i.e, the
pedicle) with variable C2 on C3
displacement.
38. Type Description Mechanism of Injury
Type I Stable. Fractures through
the pars with less than
2 mm displacement of
C2 on C3.
Axial loading and then
extension.
Type II Unstable. Significant
displacement of C2 on
C3 (>2 mm or >118
angulation). Disruption
of PLL.
Axial loading, extension, and
then rebound flexion.
Type
IIA
Less displaced but more
angulated than II.
Same as II.
Type III Pure flexion injuries. C2-
C3 facet capsules are
disrupted with
angulation and
anterolisthesis.
Compression and flexion.
39. Clinical Features
not highly specific symptoms,
diffuse neck pain with stiffness
relative sparing of the spinal cord because of
the capacious bony canal.
40. Treatment
type I may be treated in a rigid collar for
12 weeks.
remainder are all treated initially with Halo
immobilization.
up to 5% will eventually require surgery.
41. Surgical Indications
inability to reduce fracture
failure to maintain reduction in Halo vest.
C2-3 disk herniation with spinal cord
compromise.
established non-union (late)
42. Surgical Procedures
1. C1-C3 arthrodesis
2. C2 pedicle screws.
3. C2-C3 anterior discectomy with fusion
and plate.
45. Criteria for Instability
White and Panjabi also concluded that
horizontal motion between vertebrae should
not exceed 2.7 mm
(3.5 mm with standard X-ray magnification),
and angular motion should not exceed 11 mm.
46. Three column model
failure of 2 of the 3
columns implies that
there will be instability.
1. anterior column
2. middle column
3. posterior column
50. Indications for surgery
1. failure to obtain reduction
2. failure to maintain reduction
3. pseudoarthrosis
4. purely ligamentous injury
5. re-subluxation
6. any patient with jumped facets
52. Compression Burst Fractures
characterized by
axial loading injuries
to a spine which is
held in a neutral or
very slightly flexed
position.
immobilized by
traction with a Halo
vest.
54. Surgical Considerations
absolute Indications
1. inability to obtain reduction
2. inability to maintain reduction
indications for emergent surgery
1. progression of neurological deficit
2. complete myelographic or MRI CSF block
3. fragments in spinal canal in incomplete SCI
4. necessity for decompressing a cervical nerve root
5. open or penetrating trauma
6. non-reducible fractures
58. Epidemiology
represent 40% of all spine fractures
majority due to motor vehicle accidents.
grouped into
thoracic (T1-T10)
thoracolumbar (T11-L1)
lumbar fractures (L2-L5)
60% occur between T12 and L2
59. Biomechanics
In general, compression causes burst
fractures, flexion causes wedge fractures,
rotation causes fracture dislocations, and
shear causes seatbelt type fractures.
60. thoracic region is inherently more stable
because of the rib cage and ligaments
linking the ribs and spine.
the three column model states that failure of
two or more columns results in instability.
the middle column is crucial, its mode of
failure distinguishes the four types of spine
fractures.
61. Imaging
most important initial study is a complete
plain film series of the spine.
5-20% of fractures are multiple.
CT is used to define the bony anatomy in the
injured area.
MRI essential to define spinal cord anatomy
and also for assessing ligamentous injury.
62.
63. Flexion Compression Fractures
most common type of fracture.
failure of the anterior column due to flexion and
compression.
a minimum of 30% loss of ventral height is
necessary to appreciate a kyphotic deformity
on x-rays.
65. Burst Fractures
17% of major spinal fractures
between T1-T10, most burst fractures are
associated with complete neurological deficit.
bony fragments may be retropulsed into the
canal (25% of cases) and associated
fractures of the posterior elements are
common.
failure of anterior and middle column defines
these as unstable.
66.
67.
68. Management
those fractures with canal compromise in the
presence of neurological deficit should be
treated with surgical decompression and
fusion.
69.
70. the treatment of burst fractures with canal
compromise and no neurological deficit is
controversial.
generally, management is based upon
determination of stability.
those fractures with >50% loss of vertebral
body height, or if the posterior column injury
includes a facet fracture or dislocation are
considered unstable.
71.
72. commonly sited indications for surgery are
either,
i) angular deformity >15-40 degrees
ii) canal compromise >40-70%
73.
74.
75.
76. Seat Belt Injuries
6% of major spinal
injuries.
caused by
hyperflexion and
distraction of the
posterior elements.
77. the middle and posterior columns fail in
distraction with an intact anterior hinge.
unstable in flexion but will not present with an
anterior subluxation, which would indicate
that the ALL is disrupted
(i.e. a fracture-dislocation).
PLL is also intact and sometimes fracture
fragments are moved back from the canal
simply by distraction.
78. Management
treatment of mainly osseous injuries is
bracing while mainly ligamentous injuries are
treated with posterior fusion.
79. Fracture Dislocations
19% of major spinal
fractures.
anterior and cranial
displacement of the
superior vertebral body
with failure of all three
columns.
80. Extension Distraction Fractures
rare injuries.
hyperextension force tears the ALL and leads
to separation of the disc.
all are unstable and require fixation.
81. Treatment
By Degree
according to Denis, first degree is mechanical
instability, second degree is neurolgical, and
third is both.
82. first degree: manage with external orthosis
i) >30 degree wedge compression fracture
ii) Seat belt injuries.
second degree: mixed category
third degree: all require surgery
i) fracture dislocations
ii) burst fractures who fail non-operative
management
iii) burst fractures who develop new
neurological deficit
83. Non-operative Therapy
external orthosis for 8-12 weeks
serial radiographs every 2-3 weeks for the
first 3 months, then 4-6 week intervals until
6 months and at 3 month intervals for 1 year.
88. Pathophysiology
sudden loss of descending, tonic input from
the rubrospinal, vestibulospinal and the
corticospinal tracts.
89. Natural history
can last days, weeks, or occasionally months.
there is loss of facilitatory inputs which
gradually return via sprouting, membrane
hyperexcitability, and residual connections.
the stretch reflexes begin to return (flexors in
the upper extremities and extensors in the
lower extremities).
90. 4. return of bulbocavernosus reflex heralds time
course out of spinal shock.
5. mass reflexes return with cutaneous stimuli,
or bladder distension and include spasms,
colon and bladder evacuation, hypertension,
profuse sweating.
6. return of sacral reflex for bladder and bowel.
91. Treatment
1. maintain adequate intravascular volume
2. maintain blood pressure (spinal cord arterial
pressure).
3. keep bladder well decompressed; attend to
bowel routine.
4. surgical stabilization if indicated or surgical
decompression.