Subaxial Cervical Spine Injuries
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This document discusses subaxial cervical spine injuries, including: - Assessment and emergency treatment of cervical spine injuries following trauma. - Classification systems for cervical spine injuries including AO Spine, SLIC, and others which classify injuries based on morphology, neurological status, and stability. - Types of cervical injuries such as flexion-compression, burst fractures, distraction injuries, and recommendations for treatment and surgery based on classification. - Illustrative case examples of different cervical injury types classified using AO Spine and SLIC systems along with their treatments. - Key points about immobilizing the cervical spine, rational use of imaging, importance of stability especially the posterior column, and indications for early surgery.
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2) They account for 5-7% of tibial fractures and result from high-energy impacts.
3) Treatment is challenging due to articular comminution, bone loss, and soft tissue injury. Surgical management aims to reconstruct the articular surface and metaphysis while treating soft tissues.
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Similar to Subaxial Cervical Spine Injuries
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This document discusses subaxial cervical spine injuries, including their clinical spectrum and emergency treatment. It covers topics such as cervical spine immobilization, indications for surgery, classifications systems including AO Spine and SLIC, illustrative injury types like flexion-compression and distraction injuries, and recommendations for treatment. The key messages are to immobilize the cervical spine, classify injuries to determine if the spine is unstable, decompress and reconstruct any disrupted columns, consider early surgery within 12 hours when indicated, and urgently reduce bilateral locked facets in incomplete tetraplegia.
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3. Common cervical spine injuries include fractures of C1 (Atlas) and C2 (Axis) as well as fracture-dislocations. Clinical syndromes can occur based on the level and mechanism of injury.
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Os odontoideum
1) Os Odontoideum is a congenital anomaly where the odontoid process is separated from the body of C2 as a separate ossicle with no bony connection. It can be asymptomatic or cause neck pain and myelopathy.
2) Management depends on symptoms and degree of instability on imaging. Conservative treatment is used if asymptomatic with no instability. Surgical options include anterior release and posterior fusion or resection of the ossicle with fusion.
3) The document describes the embryology, classification, clinical features, imaging, and various surgical management strategies for Os Odontoideum including anterior and posterior releasing techniques and resection with fusion. Case examples are also presented.
319 thoracolumbar trauma
- Thoracolumbar injuries can cause neurological injury and long-term pain. They require assessment of fracture classification and the integrity of the posterior ligamentous complex to determine appropriate management as surgical or nonsurgical.
- Surgical approaches include posterior, anterior, or combined based on the fracture type and neurological status. Proper classification guides treatment to decompress the spine and restore stability.
- Complications include problems from immobilization as well as implant failure and infection. Careful consideration of fracture morphology, neurological findings, and ligamentous integrity directs optimal treatment.
CME Orthopedic.pptx
The document summarizes information about spine injuries, including:
- Spine injuries can be stable or unstable depending on the risk of displacement. Primary injuries involve damage to vertebral structures while secondary changes hours later involve neurological damage.
- Common mechanisms of injury include traction, direct impact, and indirect injuries. The 3 column theory states that injury to more than 1 column results in instability.
- Cervical spine injuries require careful examination and imaging like X-rays from multiple angles to identify fractures or dislocations. Thoracolumbar injuries include compression fractures which can be wedge-shaped or burst fractures.
- Initial management focuses on immobilization and ruling out injuries before clearing the spine. Diagnosis involves
Sacral fractures.pptx
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Spine injury
This document provides an overview of spinal injuries, including definitions, classifications, clinical features, investigations, and management. It defines spinal injuries as injuries to the spinal column, spinal cord, or both. Spinal injuries can be classified as complete or incomplete based on the extent of motor and sensory loss. Clinical assessment involves a detailed neurological exam to evaluate deficits. Imaging like X-rays, CT scans, and MRIs are used to investigate and classify injuries. Management depends on the type and severity of injury, and may involve immobilization, steroids, traction, or surgical decompression and stabilization.
Dr. pl srinivas ug class 1
This document discusses injuries around the elbow, including elbow dislocations, fractures of the radial head, olecranon fractures, and fractures of the neck of the radius. It covers the epidemiology, mechanisms of injury, clinical features, classifications, treatment principles and options, complications, and rehabilitation for each of these common elbow injuries. Surgical treatment may be indicated for unstable or displaced fractures to restore anatomy and stability, while simpler injuries can often be treated non-operatively with splinting and physical therapy.
U01 clavicle ac_sc_joints1
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Unstable Pelvic Fracture Presentation
Pelvic fractures can be classified based on their stability and the mechanism of injury. Unstable and partially stable fractures often require surgical fixation while stable fractures may be treated non-operatively. Initial management focuses on controlling hemorrhage through fluid resuscitation, pelvic binding, angiography, or preperitoneal packing. Definitive treatment is then aimed at anatomic reduction and stabilization of the pelvis through external or internal fixation depending on the fracture pattern and stability. Close monitoring for complications such as infection, neurological injury, or persistent instability is important.
PELVIC FRACTURES – ANATOMY, TYPES, MANAGEMENT &OUTCOME - EVIDENCE BASED ANALYSIS
This document provides an overview of pelvic fractures, including epidemiology, classification systems, imaging, management, and treatment approaches. It discusses the anatomy of the pelvic ring and mechanisms of injury. Common classification systems like Young-Burgess and Tile are described. Treatment depends on fracture type and stability, ranging from non-operative management to external or internal fixation. Internal fixation techniques are outlined for anterior and posterior ring injuries. Outcomes are often dependent on associated injuries rather than the pelvic fracture itself.
cervical Trauma classification
Trauma classification systems aim to improve communication, guide medical decisions, determine injury prognosis, and allow for standardized research. An ideal system provides both descriptive and prognostic information. Descriptively, it relays details of the traumatic condition based on consistent imaging and clinical findings. Prognostically, it accounts for injury outcomes to guide treatment. There are several classification systems for cervical spine trauma, including Holdsworth, Allen, Harris, Cervical Spine Injury Severity Score, Subaxial Cervical Spine Injury Classification, and AO Classification. They characterize injuries based on mechanism, morphology, neurologic status, and other factors. Anterior column injuries often result from hyperflexion and are identifiable on imaging as compression fractures or
X-ray spine
X-rays are commonly used to image the spine. The cervical spine can be imaged using anteroposterior, lateral, open mouth, flexion/extension, and oblique views. Key anatomical structures like the vertebrae and discs can be evaluated. Common fractures include teardrop fractures and hangman's fractures. The thoracolumbar spine is also imaged with AP and lateral views. Unstable injuries like burst fractures involve vertebral body collapse while stable injuries include wedge fractures. Spondylolysis is a stress fracture of the pars interarticularis seen best on oblique views.
Whiplash - describes a range of injuries to the neck
Whiplash describes a range of injuries to the neck caused by or related to a sudden distortion of the neck. The typical clinical picture in whiplash injury is that following the injury there is no obvious immediate pain.
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Posterior Closing Wedge Osteotomy, Decancellation and Instrumentation for the...
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Spine Trauma.pptx hgfhjddxxddghhuhbfdvhhjbff
1) Spinal cord injuries can result from trauma like car accidents or disease and affect 250,000-500,000 people worldwide each year.
2) Patients with significant trauma, loss of consciousness from minor trauma, or symptoms referable to the spine/cord should be treated as having a spinal cord injury (SCI) until proven otherwise.
3) SCI causes primary injury from initial impact and secondary injury from an ongoing cellular process, so management aims to prevent further damage through immobilization, maintaining blood pressure and oxygen levels, and limiting secondary injury cascades.
MCL,LCL & ALL injuries of the knee
MCL. LCL.ALL injuries
To understand the relevant anatomy of the side ligaments of the knee
To study the mechanism of injury of each ligament and how to diagnose such injury
To highlight the different treatment options in acute or chronic situations
Galeazzi fracture dislocation
Galeazzi fracture-dislocation is a fracture of the distal or middle third of the radius shaft combined with dislocation of the distal radioulnar joint. It most often occurs in males due to indirect trauma from a fall on an outstretched hand with rotation. Radiographs show the radial fracture and dislocation of the distal radioulnar joint. Treatment involves open reduction and internal fixation of the radial fracture with a plate while restoring length and stability of the distal radioulnar joint. The forearm is then immobilized in supination for 4-6 weeks to heal.
Spinetrauma 2
1. The document discusses the approach to evaluating and diagnosing spinal trauma, with a focus on cervical spine injuries. It covers spinal anatomy, epidemiology, mechanisms of injury, clinical evaluation, and diagnostic imaging.
2. Key points discussed include the NEXUS and Canadian C-Spine Rules for determining when cervical spine radiography is necessary, how to read cervical spine x-rays, and challenges in clearing the cervical spine in unconscious or intubated patients.
3. CT scanning and MRI are more sensitive than plain films for detecting injuries, but have limitations. Clinical examination is important but impossible in unconscious patients, who require continued spinal precautions until fully conscious.
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1) Hypothermia has been proposed as a treatment for traumatic brain injury (TBI) to help reduce secondary brain damage.
2) Previous studies on hypothermia for TBI have shown mixed results, with some trials finding benefits and others finding no effect.
3) The author conducted a randomized controlled trial of 107 patients with severe TBI to study the effects of progesterone, hypothermia, or their combination on outcomes.
4) The trial found the best outcomes based on Glasgow Outcome Scale at 6 months in the hypothermia group, followed by the progesterone group, though the combination did not provide additional benefit over hypothermia alone.
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1) Hypothermia has been proposed as a treatment for traumatic brain injury (TBI) to help reduce secondary brain damage.
2) Previous studies on hypothermia for TBI have shown mixed results, with some trials finding benefits and others finding no effect.
3) The author conducted a randomized controlled trial of 107 patients with severe TBI to study the effects of progesterone, hypothermia, or their combination on outcomes.
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Basics of Electrocardiogram
CONTENTS
●Conduction System of the Heart
●What is ECG or EKG?
●ECG Leads
●Normal waves of ECG.
●Dimensions of ECG.
● Abnormalities of ECG
CONDUCTION SYSTEM OF THE HEART
ECG:
●ECG is a graphic record of the electrical activity of the heart.
●Electrical activity precedes the mechanical activity of the heart.
●Electrical activity has two phases:
Depolarization- contraction of muscle
Repolarization- relaxation of muscle
ECG Leads:
●6 Chest leads
●6 Limb leads
1. Bipolar Limb Leads:
Lead 1- Between right arm(-ve) and left arm(+ve)
Lead 2- Between right arm(-ve) and left leg(+ve)
Lead 3- Between left arm(-ve)
and left leg(+ve)
2. Augmented unipolar Limb Leads:
AvR- Right arm
AvL- Left arm
AvF- Left leg
3.Chest Leads:
V1 : Over 4th intercostal
space near right sternal margin
V2: Over 4th intercostal space near left sternal margin
V3:In between V2 and V4
V4:Over left 5th intercostal space on the mid
clavicular line
V5:Over left 5th intercostal space on the anterior
axillary line
V6:Over left 5th intercostal space on the mid
axillary line.
Normal ECG:
Waves of ECG:
P Wave
•P Wave is a positive wave and the first wave in ECG.
•It is also called as atrial complex.
Cause: Atrial depolarisation
Duration: 0.1 sec
QRS Complex:
•QRS’ complex is also called the initial ventricular complex.
•‘Q’ wave is a small negative wave. It is continued as the tall ‘R’ wave, which is a positive wave.
‘R’ wave is followed by a small negative wave, the ‘S’ wave.
Cause:Ventricular depolarization and atrial repolarization
Duration: 0.08- 0.10 sec
T Wave:
•‘T’ wave is the final ventricular complex and is a positive wave.
Cause:Ventricular repolarization Duration: 0.2 sec
Intervals and Segments of ECG:
P-R Interval:
•‘P-R’ interval is the interval
between the onset of ‘P’wave and onset of ‘Q’ wave.
•‘P-R’ interval cause atrial depolarization and conduction of impulses through AV node.
Duration:0.18 (0.12 to 0.2) sec
Q-T Interval:
•‘Q-T’ interval is the interval between the onset of ‘Q’
wave and the end of ‘T’ wave.
•‘Q-T’ interval indicates the ventricular depolarization
and ventricular repolarization,
i.e. it signifies the
electrical activity in ventricles.
Duration:0.4-0.42sec
S-T Segment:
•‘S-T’ segment is the time interval between the end of ‘S’ wave and the onset of ‘T’ wave.
Duration: 0.08 sec
R-R Interval:
•‘R-R’ interval is the time interval between two consecutive ‘R’ waves.
•It signifies the duration of one cardiac cycle.
Duration: 0.8 sec
Dimension of ECG:
How to find heart rhytm of the heart?
Regular rhytm:
Irregular rhytm:
More than or less than 4
How to find heart rate using ECG?
If heart Rhytm is Regular :
Heart rate =
300/No.of large b/w 2 QRS complex
= 300/4
=75 beats/mins
How to find heart rate using ECG?
If heart Rhytm is irregular:
Heart rate = 10×No.of QRS complex in 6 sec 5large box = 1sec
5×6=30
10×7 = 70 Beats/min
Abnormalities of ECG:
Cardiac Arrythmias:
1.Tachycardia
Heart Rate more than 100 beats/min
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原版定制【微信:bwp0011】《(uofm毕业证书)美国密歇根大学毕业证学位证书》【微信:bwp0011】成绩单 、雅思、外壳、留信学历认证永久存档查询，采用学校原版纸张、特殊工艺完全按照原版一比一制作（包括：隐形水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠，文字图案浮雕，激光镭射，紫外荧光，温感，复印防伪）行业标杆！精益求精，诚心合作，真诚制作！多年品质 ,按需精细制作，24小时接单,全套进口原装设备，十五年致力于帮助留学生解决难题，业务范围有加拿大、英国、澳洲、韩国、美国、新加坡，新西兰等学历材料，包您满意。
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3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
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6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
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Subaxial Cervical Spine Injuries
- 1. SUBAXIAL CERVICAL SPINE INJURIES- CLINICAL SPECTRUM AND EMERGENCY TREATMENT Dr Sumit Sinha MS, DNB, MCh Additional Professor Deptt of Neurosurgery, AIIMS and JPNATC, New Delhi Faculty, Advanced trauma Life Support Faculty, AO Spine
- 2. SUBAXIAL CERVICAL SPINE INJURIES Assessment of Cervical spine injuries • AIRWAY+ CERVICAL SPINE IMMOBILIZATION • BREATHING • CIRCULATION • DISABILITY • EXPOSURE 2
- 3. SUBAXIAL CERVICAL SPINE INJURIES NEXUS Low risk criteria Cervical spine imaging recommended for all pts with trauma EXCEPT • No midline tenderness • No intoxication • Normal alertness • No FND • No other injuries 3 *Hoffman JR et al. Ann Emerg Med 1998;32:461-469
- 4. SUBAXIAL CERVICAL SPINE INJURIES Indications for Surgery • Unstable injuries • Injuries with neurological deficits with proven mechanical compression • Inability to reduce dislocation by closed means • To facilitate nursing care 4
- 5. SUBAXIAL CERVICAL SPINE INJURIES INSTABILITY White and Punjabi et al • ‘the loss of the spine’s ability to maintain its patterns of displacement under physiologic loads so there is no initial or additional neurologic deficit, no major deformity, and no incapacitating pain’ 5 *A.A. White, M.M. Panjabi (Eds.), Clinical biomechanics of the spine, 2nd ed, JB Lippincott, Philadelphia, PA, 1990.
- 6. SUBAXIAL CERVICAL SPINE INJURIES INSTABILITY Anterior Column Middle Column Posterior Column Anterior third VB, disc, ALL Posterior third VB and Disc, PLL Posterior spinal arch and laminae 6
- 7. SUBAXIAL CERVICAL SPINE INJURIES Classification systems • Nicoll et al- functional outcomes • Holdsworth et al- stable/ unstable- PLC integrity • White and Punjabi- neurology, radiology, stretch test • Allen et al- mechanistic • Harris et al • AO Spine • CSISS • SLIC 7
- 8. SUBAXIAL CERVICAL SPINE INJURIES Classification systems 8
- 9. SUBAXIAL CERVICAL SPINE INJURIES Classification systems AO Spine • Type A- compression • Type B- Distraction • Type C- Rotation *Magerl F et al. Eur Spine J 1994;3:184-201 9
- 10. SUBAXIAL CERVICAL SPINE INJURIES Classification systems A B C 1 Impaction Posterior disruption- ligamentous Rotational wedge 2 Split Posterior disruption- bony Rotational split 3 Burst Anterior disruption- disc Rotational burst AO Spine 10
- 11. *Vaccaro et al. AO Spine Knowledge forum- TLICS validation study 11
- 12. SUBAXIAL CERVICAL SPINE INJURIES Classification systems Neurological Modifiers • N0-No Neurological deficit • N1- transient deficit, resolved • N2- Radiculopathy • N3- incomplete SCI / CES • N4- complete SCI • NX- cant be assessed Patient specific modifiers • M1- Indeterminate tension band injury • M2- comorbidity (DISH/ AS) *Vaccaro et al. AO Spine Knowledge forum- TLICS validation study 12
- 13. Classification systems Subaxial cervical injury severity score (SLIC) *Vaccaro AR et al. Spine 2007;32:2365-74 **Vaccaro AR et al. Spine 2005;30(20):2325-33 Morphology Points No Abn 0 Compression 1 Burst 2 Distraction 3 Rotation/ translation 4 PLC Intact 0 Indeterminate 1 Disrupted 2 Neurology Intact 0 Root Injury 1 Complete cord injury 2 Incomplete cord injury 3 Continuous cord compression +1 13
- 14. Classification systems Subaxial cervical injury severity score (SLIC) Burst morphology (2)- Type A3 Compression morphology (1)- Type A1,A1 14
- 15. Classification systems Subaxial cervical injury severity score (SLIC) Translation/Rotation morphology (4)- Type C Distraction Morphology (3)- Type B1, B2, B3 15
- 16. SUBAXIAL CERVICAL SPINE INJURIES Flexion-Compression Injuries (Type A2,A3 ,B1 and C AO Spine SLIC- Compression/ Burst) Rizzolo SJ et al. J Am Acad Orthop Surg. 1993:1:57-66 rigid orthosis Sx- Ventral/ dorsal/ 360° 16
- 17. SUBAXIAL CERVICAL SPINE INJURIES Classification systems Flexion-Compression Injuries 17
- 18. SUBAXIAL CERVICAL SPINE INJURIES Classification systems Vertical Compression (Burst) Injury (Type A3 AO Spine/ SLIC- Compression/ Burst) 18
- 19. • Recommendations for SLIC Burst inuries 19
- 20. SUBAXIAL CERVICAL SPINE INJURIES Classification systems Compression Extension Injury (Type B3, C AO Spine, SLIC- Distraction) 20
- 21. SUBAXIAL CERVICAL SPINE INJURIES Classification systems Distractive Extension Injuries (Type B3, C AO Spine- SLIC- Distraction) ACDF+ Plating 360 ° Fusion Skeletal traction- CAUTION 21
- 22. Recommendations for SLIC Hyperextension inuries 22
- 23. SUBAXIAL CERVICAL SPINE INJURIES Distractive flexion Injuries (Type B1,B2 and C AO Spine SLIC- Translation/ Distraction) 23 URGENT CLOSED/ OPEN REDUCTION
- 24. Recommendations for SLIC Rotation/ translation inuries 24
- 25. SUBAXIAL CERVICAL SPINE INJURIES Illustrative Cases Distractive flexion Injury Stage 3 Type B2 # SLIC- 3+2+2=7 25
- 26. SUBAXIAL CERVICAL SPINE INJURIES Illustrative Cases Distraction Hyperextension Injury Stage 2 Type B3 # SLIC- 3+2+1=6 26
- 27. SUBAXIAL CERVICAL SPINE INJURIES Illustrative Cases Distractive Flexion Injury Stage 3 Type C# SLIC- 3+2+2=7 27
- 28. SUBAXIAL CERVICAL SPINE INJURIES Illustrative Cases Vertical Compression Injury Type A3 # SLIC- 2+0+3+1=6 28
- 29. SUBAXIAL CERVICAL SPINE INJURIES Illustrative Cases Distractive Flexion Injury Stage 3 Type B1 # SLIC- 3+2+3=8 29
- 30. SUBAXIAL CERVICAL SPINE INJURIES Illustrative Cases Compression Flexion Injury Stage III Type B2 # SLIC- 2+1+3=6 30
- 31. SUBAXIAL CERVICAL SPINE INJURIES Illustrative Cases Flexion Compression Injury Stage 3 Type A2 # SLIC- 1+1+3=5 31
- 32. SUBAXIAL CERVICAL SPINE INJURIES Illustrative Cases Distraction Hyperextension Injury Type 1 Type B3 # SLIC- 3+1+3=7 32
- 33. SUBAXIAL CERVICAL SPINE INJURIES TAKE HOME MESSAGE • IMMOBILIZE C-Spine- Priority • Rationalization of Radiography- 10% contiguous spine # • Look for instability- Classify- Decompress and Reconstitute the column which is disrupted • Posterior column most important for stability- reconstitute whenever disrupted • EARLY SURGERY- ?? hours (Level III evidence) • Urgent reduction of bilateral locked facets in incomplete tetraplegia- (Level II evidence)- Closed OR open reduction- Role of Pre-reduction MR ? 33
- 34. THANKYOU FOR YOUR ATTENTION 34