1. Thoracolumbar spinal injuries most commonly occur in the T11-L2 region due to the anatomical transition from the rigid thoracic spine to the more mobile lumbar spine.
2. They present with pain, loss of function, and potentially neurological deficits depending on the severity of the injury. Common causes are axial compression, flexion/distraction, or rotation.
3. Treatment depends on the fracture classification (AO/Denis), stability, and presence of neurological deficits. Unstable or injuries with deficits generally require surgical stabilization to restore alignment and prevent further injury, while stable injuries may be treated non-operatively with bracing or casting.
The document summarizes thoracolumbar spine injuries, including:
- Anatomy of the thoracic and lumbar spine regions which predispose the thoracolumbar junction to injury.
- Epidemiology showing these injuries most commonly affect segments T11-L2 and have bimodal age distribution.
- Classification systems including Denis, McCormack, and TLICS which evaluate morphology, neurology, and ligamentous integrity to determine treatment.
- Treatment principles aim to preserve neurology, minimize compression, stabilize the spine, and rehabilitate the patient either via non-operative or operative means.
This document discusses thoracolumbar fractures of the spine. It begins by describing the anatomy of the spine and functional spinal units. It then discusses the physiological anatomy of the thoracic and lumbar spine. It describes the etiology, classifications including the Denis three-column theory and AO/MAGREL classification, clinical presentations, investigations including x-rays, CT and MRI, and classifications of spinal instability for thoracolumbar fractures.
1. Immobilize the cervical spine and obtain imaging of the full spine including CT scan of the cervical spine to evaluate for fractures or ligamentous injuries.
2. Perform neurological examination and assess for signs of spinal cord injury such as motor and sensory deficits.
3. Maintain adequate perfusion with intravenous fluids to achieve a mean arterial pressure of 85 mmHg to support cord perfusion.
4. Administer steroids such as methylprednisolone if spinal cord injury is present based on imaging and neurological exam findings.
5. Determine need for surgical stabilization and decompression depending on fracture pattern and presence
Sacral fractures are common pelvic injuries that are often missed. They can cause neurologic injury and require careful assessment and classification to determine appropriate treatment. Non-displaced or minimally displaced fractures may be treated non-operatively with rest, but displaced or unstable fractures often require surgical fixation using techniques like percutaneous screws, plates, rods or decompression of neural structures. Careful imaging and consideration of fracture pattern and neurologic involvement are needed to select the best treatment approach.
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
- 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.
Thoraco-lumbar fractures are common injuries that occur primarily from motor vehicle accidents. Several classification systems exist to characterize the injuries including the commonly used Denis classification, Load Sharing classification, and AO classification system. The Thoracolumbar Injury Classification and Severity Score (TLICS) system incorporates injury morphology, neurological status, and posterior ligamentous complex integrity to determine a score to guide treatment decisions. A score of 4 or less generally indicates non-surgical management while a score of 5 or more indicates surgery is needed. The timing of surgery remains unclear but early decompression may improve outcomes in neurologically compromised patients. Treatment is based on fracture stability, deformity, and neurological status.
The document summarizes thoracolumbar spine injuries, including:
- Anatomy of the thoracic and lumbar spine regions which predispose the thoracolumbar junction to injury.
- Epidemiology showing these injuries most commonly affect segments T11-L2 and have bimodal age distribution.
- Classification systems including Denis, McCormack, and TLICS which evaluate morphology, neurology, and ligamentous integrity to determine treatment.
- Treatment principles aim to preserve neurology, minimize compression, stabilize the spine, and rehabilitate the patient either via non-operative or operative means.
This document discusses thoracolumbar fractures of the spine. It begins by describing the anatomy of the spine and functional spinal units. It then discusses the physiological anatomy of the thoracic and lumbar spine. It describes the etiology, classifications including the Denis three-column theory and AO/MAGREL classification, clinical presentations, investigations including x-rays, CT and MRI, and classifications of spinal instability for thoracolumbar fractures.
1. Immobilize the cervical spine and obtain imaging of the full spine including CT scan of the cervical spine to evaluate for fractures or ligamentous injuries.
2. Perform neurological examination and assess for signs of spinal cord injury such as motor and sensory deficits.
3. Maintain adequate perfusion with intravenous fluids to achieve a mean arterial pressure of 85 mmHg to support cord perfusion.
4. Administer steroids such as methylprednisolone if spinal cord injury is present based on imaging and neurological exam findings.
5. Determine need for surgical stabilization and decompression depending on fracture pattern and presence
Sacral fractures are common pelvic injuries that are often missed. They can cause neurologic injury and require careful assessment and classification to determine appropriate treatment. Non-displaced or minimally displaced fractures may be treated non-operatively with rest, but displaced or unstable fractures often require surgical fixation using techniques like percutaneous screws, plates, rods or decompression of neural structures. Careful imaging and consideration of fracture pattern and neurologic involvement are needed to select the best treatment approach.
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
- 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.
Thoraco-lumbar fractures are common injuries that occur primarily from motor vehicle accidents. Several classification systems exist to characterize the injuries including the commonly used Denis classification, Load Sharing classification, and AO classification system. The Thoracolumbar Injury Classification and Severity Score (TLICS) system incorporates injury morphology, neurological status, and posterior ligamentous complex integrity to determine a score to guide treatment decisions. A score of 4 or less generally indicates non-surgical management while a score of 5 or more indicates surgery is needed. The timing of surgery remains unclear but early decompression may improve outcomes in neurologically compromised patients. Treatment is based on fracture stability, deformity, and neurological status.
Thoraco-lumbar fractures are common injuries that occur primarily from motor vehicle accidents. Several classification systems exist to characterize the injuries including the commonly used Denis classification, Load Sharing classification, and AO classification system. The Thoracolumbar Injury Classification and Severity Score (TLICS) system incorporates injury morphology, neurological status, and posterior ligamentous complex integrity to determine a score to guide treatment decisions. A score of 4 or less generally indicates non-surgical management while a score of 5 or more indicates surgery is needed. The timing of surgery remains unclear but early decompression may improve outcomes in neurologically incomplete injuries. Treatment is based on fracture stability, deformity, and neurological status.
This document provides an overview of spine injuries, including anatomy, imaging techniques, fracture types, and management. It discusses the cervical, thoracic, and lumbar regions of the spine. Common fracture types like compression, burst, Chance, and Jefferson fractures are described along with their mechanisms and radiographic features. The AO classification system and three column concept are introduced. Interpretation of x-rays, CT scans and MRI images is outlined. Factors like the TLICS score and integrity of the posterior ligamentous complex are discussed in determining non-operative vs operative management of various spine fractures and injuries.
Thoracolumbar spine Injuries by Dr Rohan DhotreDrRohanDhotre
1. Thoracolumbar spine injuries most commonly occur at T11-L1 and are usually due to high-energy trauma like motor vehicle accidents or falls.
2. Classification systems like Denis column theory and AO/Magerl system help characterize the injury and guide treatment.
3. Treatment depends on the fracture type and neurological status. Uncomplicated compression fractures are typically managed conservatively while injuries involving the posterior ligaments or with neurological deficits usually require surgery.
This document discusses fractures, including their causes, types, patterns, locations, and management. It provides information on commonly fractured bones like the clavicle, radius/ulna, and femoral neck. Key points covered include the goals of fracture treatment being sound union without deformity or loss of function. Management principles involve reduction, immobilization, and rehabilitation. Complications like infection, malunion, and compartment syndrome are also summarized.
This document discusses the radiological evaluation of appendicular skeletal trauma. It begins by describing the different parts of the appendicular skeleton and various imaging modalities used to evaluate trauma, including plain radiographs, ultrasound, CT, MRI and others. It then covers the classification of fractures, focusing on the upper limb trauma including fractures and dislocations of the shoulder, elbow, forearm, wrist and hand. Examples of specific fracture patterns are provided.
These slides contains information regarding fractures and dislocations of spine, various classifications of fracture spine, approach to fractures of spine, criteria for surgical or conservative management of patient, various named fractures involving cervical spine and brief description of spine fracture dislocation.
This document provides information on orthopaedic spinal injuries from Zagazig University in Egypt. It discusses several topics in 3 paragraphs or less:
Spinal injuries are less common than extremity injuries but have worse functional outcomes. They involve the cervical, thoracic, and lumbar spine. Neurological involvement is common in high-energy trauma or polytrauma patients.
Cervical spine injuries account for one-third of spinal injuries. The C2 vertebrae and lower C6-C7 vertebrae are most commonly injured. A neurological injury occurs in 15% of spine trauma patients. Exam of the peripheral nervous system is important to fully assess injuries.
Initial management follows ATLS protocols - stabilize
This document discusses the anatomy, classification, treatment, and complications of proximal femoral fractures. It begins by covering the anatomy of the proximal femur and blood supply. It then discusses the AO classification system and Garden classification for femoral neck fractures. Treatment options are presented for different fracture types, including internal fixation and hemiarthroplasty. Complications of various treatments like nonunion and avascular necrosis are also summarized. Studies comparing treatments like screw fixation versus hemiarthroplasty in elderly patients are reviewed.
Thoracolumbar fractures account for 50% of spinal fractures and often occur between the T9 and L2 vertebrae. They are commonly caused by high-energy trauma like motor vehicle accidents or falls. Assessment involves neurological examination, imaging like x-rays and CT scans to evaluate bone injury and MRI to assess soft tissues. Treatment depends on factors like degree of vertebral compression and kyphosis, with non-operative options for mild cases and surgical stabilization and fusion for more severe injuries or neurological compromise. Rehabilitation focuses on restoring function, preventing complications, and bracing to solidify healing.
This document discusses the anatomy and physiology of the thoracolumbar spine and classifies different types of thoracolumbar spine injuries. It describes the anatomy of the spinal cord, blood supply, and biomechanics of the thoracic and lumbar regions. Various injury mechanisms are outlined including compression fractures, burst fractures, and chance fractures. Imaging techniques like x-rays, CT, and MRI are discussed. The Denis three-column theory and TLICS classification system are introduced to classify injuries as stable or unstable. Non-operative and surgical treatment options are provided based on the injury classification.
This document provides an overview of spinal trauma. It begins with relevant spinal anatomy and the epidemiology of spinal injuries. The most common mechanisms of injury are motor vehicle accidents and falls. Clinical signs include neurological deficits that correspond to the level and completeness of injury. Radiological imaging such as X-rays, CT, and MRI are used to identify fractures and spinal instability. Early management focuses on immobilization, corticosteroids, and treating associated conditions like neurogenic shock. Surgical stabilization is indicated for incomplete injuries with neural compression or unstable fractures with neurological deficits. The goals of treatment are to preserve neurological function, minimize compression, stabilize the spine, and rehabilitate the patient.
This document provides a classification and overview of injuries around various joints of the lower extremity, including the hip, knee, ankle, and foot. It begins by classifying injuries around the hip into pelvic injuries, femoral neck fractures, proximal femur fractures, and hip dislocations. It then discusses fractures of the femoral shaft, injuries around the knee including ligament injuries and fractures, and fractures of the tibia and fibula. Finally, it outlines injuries around the ankle, foot, and its phalanges, metatarsals, and sesamoid bones. The document provides brief descriptions and examples for each type of injury.
Traumatic paraplegia & bladder management by dr ashutoshAshutosh Kumar
1) Traumatic paraplegia refers to spinal cord injury in the thoracic, lumbar, or sacral regions resulting in loss of muscle strength in the lower extremities. Initial management involves immobilization and transport to the emergency room for evaluation.
2) The bladder is commonly affected after paraplegia, resulting in either a flaccid or spastic bladder depending on the level of injury. Long-term management involves preventing complications like pressure ulcers, spasticity, and blood clots through rehabilitation therapies.
3) Rehabilitation is critical after spinal cord injury and involves a multidisciplinary team to address issues like bladder management, skin care, spasticity management, and prevention of secondary complications. The
This document provides information on proximal humerus fractures, including:
1. The anatomy of the proximal humerus and forces that cause deformity.
2. Classification systems for proximal humerus fractures including Neer's classification.
3. Surgical techniques for open reduction and internal fixation of displaced proximal humerus fractures using a proximal humerus locking plate. The procedure is described in 4 steps.
This document discusses cervical spondylosis and its management. It begins with the anatomy of the cervical spine and describes the intervertebral discs and muscles. It then covers the biomechanics, epidemiology, etiology, clinical manifestations, investigations, differential diagnosis, and management including medical, surgical, and physiotherapy approaches. The goals of physiotherapy treatment are to relieve pain, improve neck movement and posture, and decrease reliance on pain medications. Exercises and modalities like heat, cold, traction, and electrical stimulation are used.
This document provides an overview of tibial plateau fractures, including anatomy, classification systems, mechanisms of injury, diagnosis, and management. It describes the Shatzker and AO/OTA classification systems. Diagnosis involves history, physical exam, and imaging like X-rays, CT, and MRI. Treatment depends on the fracture type but generally involves closed reduction for nondisplaced fractures and open reduction with internal fixation using plates, screws, or external fixation for displaced fractures to restore alignment and the articular surface. Complications can include infection, DVT, loss of fixation, and posttraumatic arthritis.
Avascular necrosis of the femoral head results from interrupted blood supply to the bone. It commonly occurs after hip fractures or dislocations. Symptoms include pain in the groin or hip that worsens with activity. Imaging studies can detect changes over time. Treatment options range from non-surgical measures like limited weight bearing to surgical procedures like core decompression, bone grafting, or hip replacement depending on the stage of necrosis. Prognosis depends on the stage at diagnosis, with many requiring surgery within 3 years and risk of developing necrosis in the other hip.
Avascular necrosis (AVN) of the femoral head is a pathologic process that results from interruption of blood supply to the bone. AVN of the hip is poorly understood, but this process is the final common pathway of traumatic or nontraumatic factors that compromise the already precarious circulation of the femoral head. Femoral head ischemia results in the death of marrow and osteocytes and usually results in the collapse of the necrotic segment
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Thoraco-lumbar fractures are common injuries that occur primarily from motor vehicle accidents. Several classification systems exist to characterize the injuries including the commonly used Denis classification, Load Sharing classification, and AO classification system. The Thoracolumbar Injury Classification and Severity Score (TLICS) system incorporates injury morphology, neurological status, and posterior ligamentous complex integrity to determine a score to guide treatment decisions. A score of 4 or less generally indicates non-surgical management while a score of 5 or more indicates surgery is needed. The timing of surgery remains unclear but early decompression may improve outcomes in neurologically incomplete injuries. Treatment is based on fracture stability, deformity, and neurological status.
This document provides an overview of spine injuries, including anatomy, imaging techniques, fracture types, and management. It discusses the cervical, thoracic, and lumbar regions of the spine. Common fracture types like compression, burst, Chance, and Jefferson fractures are described along with their mechanisms and radiographic features. The AO classification system and three column concept are introduced. Interpretation of x-rays, CT scans and MRI images is outlined. Factors like the TLICS score and integrity of the posterior ligamentous complex are discussed in determining non-operative vs operative management of various spine fractures and injuries.
Thoracolumbar spine Injuries by Dr Rohan DhotreDrRohanDhotre
1. Thoracolumbar spine injuries most commonly occur at T11-L1 and are usually due to high-energy trauma like motor vehicle accidents or falls.
2. Classification systems like Denis column theory and AO/Magerl system help characterize the injury and guide treatment.
3. Treatment depends on the fracture type and neurological status. Uncomplicated compression fractures are typically managed conservatively while injuries involving the posterior ligaments or with neurological deficits usually require surgery.
This document discusses fractures, including their causes, types, patterns, locations, and management. It provides information on commonly fractured bones like the clavicle, radius/ulna, and femoral neck. Key points covered include the goals of fracture treatment being sound union without deformity or loss of function. Management principles involve reduction, immobilization, and rehabilitation. Complications like infection, malunion, and compartment syndrome are also summarized.
This document discusses the radiological evaluation of appendicular skeletal trauma. It begins by describing the different parts of the appendicular skeleton and various imaging modalities used to evaluate trauma, including plain radiographs, ultrasound, CT, MRI and others. It then covers the classification of fractures, focusing on the upper limb trauma including fractures and dislocations of the shoulder, elbow, forearm, wrist and hand. Examples of specific fracture patterns are provided.
These slides contains information regarding fractures and dislocations of spine, various classifications of fracture spine, approach to fractures of spine, criteria for surgical or conservative management of patient, various named fractures involving cervical spine and brief description of spine fracture dislocation.
This document provides information on orthopaedic spinal injuries from Zagazig University in Egypt. It discusses several topics in 3 paragraphs or less:
Spinal injuries are less common than extremity injuries but have worse functional outcomes. They involve the cervical, thoracic, and lumbar spine. Neurological involvement is common in high-energy trauma or polytrauma patients.
Cervical spine injuries account for one-third of spinal injuries. The C2 vertebrae and lower C6-C7 vertebrae are most commonly injured. A neurological injury occurs in 15% of spine trauma patients. Exam of the peripheral nervous system is important to fully assess injuries.
Initial management follows ATLS protocols - stabilize
This document discusses the anatomy, classification, treatment, and complications of proximal femoral fractures. It begins by covering the anatomy of the proximal femur and blood supply. It then discusses the AO classification system and Garden classification for femoral neck fractures. Treatment options are presented for different fracture types, including internal fixation and hemiarthroplasty. Complications of various treatments like nonunion and avascular necrosis are also summarized. Studies comparing treatments like screw fixation versus hemiarthroplasty in elderly patients are reviewed.
Thoracolumbar fractures account for 50% of spinal fractures and often occur between the T9 and L2 vertebrae. They are commonly caused by high-energy trauma like motor vehicle accidents or falls. Assessment involves neurological examination, imaging like x-rays and CT scans to evaluate bone injury and MRI to assess soft tissues. Treatment depends on factors like degree of vertebral compression and kyphosis, with non-operative options for mild cases and surgical stabilization and fusion for more severe injuries or neurological compromise. Rehabilitation focuses on restoring function, preventing complications, and bracing to solidify healing.
This document discusses the anatomy and physiology of the thoracolumbar spine and classifies different types of thoracolumbar spine injuries. It describes the anatomy of the spinal cord, blood supply, and biomechanics of the thoracic and lumbar regions. Various injury mechanisms are outlined including compression fractures, burst fractures, and chance fractures. Imaging techniques like x-rays, CT, and MRI are discussed. The Denis three-column theory and TLICS classification system are introduced to classify injuries as stable or unstable. Non-operative and surgical treatment options are provided based on the injury classification.
This document provides an overview of spinal trauma. It begins with relevant spinal anatomy and the epidemiology of spinal injuries. The most common mechanisms of injury are motor vehicle accidents and falls. Clinical signs include neurological deficits that correspond to the level and completeness of injury. Radiological imaging such as X-rays, CT, and MRI are used to identify fractures and spinal instability. Early management focuses on immobilization, corticosteroids, and treating associated conditions like neurogenic shock. Surgical stabilization is indicated for incomplete injuries with neural compression or unstable fractures with neurological deficits. The goals of treatment are to preserve neurological function, minimize compression, stabilize the spine, and rehabilitate the patient.
This document provides a classification and overview of injuries around various joints of the lower extremity, including the hip, knee, ankle, and foot. It begins by classifying injuries around the hip into pelvic injuries, femoral neck fractures, proximal femur fractures, and hip dislocations. It then discusses fractures of the femoral shaft, injuries around the knee including ligament injuries and fractures, and fractures of the tibia and fibula. Finally, it outlines injuries around the ankle, foot, and its phalanges, metatarsals, and sesamoid bones. The document provides brief descriptions and examples for each type of injury.
Traumatic paraplegia & bladder management by dr ashutoshAshutosh Kumar
1) Traumatic paraplegia refers to spinal cord injury in the thoracic, lumbar, or sacral regions resulting in loss of muscle strength in the lower extremities. Initial management involves immobilization and transport to the emergency room for evaluation.
2) The bladder is commonly affected after paraplegia, resulting in either a flaccid or spastic bladder depending on the level of injury. Long-term management involves preventing complications like pressure ulcers, spasticity, and blood clots through rehabilitation therapies.
3) Rehabilitation is critical after spinal cord injury and involves a multidisciplinary team to address issues like bladder management, skin care, spasticity management, and prevention of secondary complications. The
This document provides information on proximal humerus fractures, including:
1. The anatomy of the proximal humerus and forces that cause deformity.
2. Classification systems for proximal humerus fractures including Neer's classification.
3. Surgical techniques for open reduction and internal fixation of displaced proximal humerus fractures using a proximal humerus locking plate. The procedure is described in 4 steps.
This document discusses cervical spondylosis and its management. It begins with the anatomy of the cervical spine and describes the intervertebral discs and muscles. It then covers the biomechanics, epidemiology, etiology, clinical manifestations, investigations, differential diagnosis, and management including medical, surgical, and physiotherapy approaches. The goals of physiotherapy treatment are to relieve pain, improve neck movement and posture, and decrease reliance on pain medications. Exercises and modalities like heat, cold, traction, and electrical stimulation are used.
This document provides an overview of tibial plateau fractures, including anatomy, classification systems, mechanisms of injury, diagnosis, and management. It describes the Shatzker and AO/OTA classification systems. Diagnosis involves history, physical exam, and imaging like X-rays, CT, and MRI. Treatment depends on the fracture type but generally involves closed reduction for nondisplaced fractures and open reduction with internal fixation using plates, screws, or external fixation for displaced fractures to restore alignment and the articular surface. Complications can include infection, DVT, loss of fixation, and posttraumatic arthritis.
Avascular necrosis of the femoral head results from interrupted blood supply to the bone. It commonly occurs after hip fractures or dislocations. Symptoms include pain in the groin or hip that worsens with activity. Imaging studies can detect changes over time. Treatment options range from non-surgical measures like limited weight bearing to surgical procedures like core decompression, bone grafting, or hip replacement depending on the stage of necrosis. Prognosis depends on the stage at diagnosis, with many requiring surgery within 3 years and risk of developing necrosis in the other hip.
Avascular necrosis (AVN) of the femoral head is a pathologic process that results from interruption of blood supply to the bone. AVN of the hip is poorly understood, but this process is the final common pathway of traumatic or nontraumatic factors that compromise the already precarious circulation of the femoral head. Femoral head ischemia results in the death of marrow and osteocytes and usually results in the collapse of the necrotic segment
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The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
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2. EPIDEMIOLOGY
• more frequent in men (2/3) than in women (1/3)
• peak between 20 to 40 years
• 50–60% of thoracolumbar fractures affect the transition T11–L2,
• 25–40% the thoracic spine and
• 10–14% the lower lumbar spine and sacrum
( Journal of Neurosurgery: Spine. 2002 Jan 1;96(1):56-61)
3. EPIDEMIOLOGY
• German Trauma Society studied 682 patients and revealed 50% LV1
fractures, 25% T12 fractures, and 21% LV2 fractures [65].
• University Hospital in Zürich demonstrated a very similar
distribution for operated spine fractures (1992–2004, n=1744): 20%
cervical spine, 8%thoracic spine T1–T10 , 62% thoracolumbar spine
T11–L2 , and 10% lumbosacral spine L3-sacrum
4. ANATOMICAL REASONS FOR SUSCEPTIBILITY OF
THORACOLUMBAR TRANSITION
• transition from a relatively rigid thoracic kyphosis to a more mobile
lumbar lordosis occurs at. T11–12.
• less stability by lowest ribs (T11 and T12) compared to the rostral thoracic
region, because they are free floating.
• The facet joints of the thoracic region are oriented in the coronal (frontal)
plane, limiting flexion and extension while providing substantial resistance
to anteroposterior translation
• In the lumbosacral region, the facet joints are oriented in a more sagittal
alignment, which increases the degree of potential flexion and extension
at the expense of limiting lateral bending and rotation.
5. • In thoracolumbar spine fractures (T1–L5), Magerl et al. [81] and Gertzbein
[47] reported 22% and 35.8% neurological deficiencies, respectively.
• German Society of Traumatology [65] revealed neurological deficiencies in
22–51%, depending on the fracture type (22%in Type A fractures, 28%in
Type B fractures, and 51% in Type C fractures, (AO classification).
• Complete paraplegia was found in 5%of the patients with fractures of the
thoracolumbar transition.
6. Pathomechanisms
• most relevant forces are
– Axial compression
• (incomplete or complete burst fractures)
– Flexion/distraction
• Pure osseous lesion
• Mixed osteoligamentous lesion
• Pure soft tissue (ligamentous or disc) lesion
– Hyperextension
• facet, lamina, and spinous process fractures
– Rotation
• fracture dislocations
– Shear)
• ligamentous disruption
• anterior, posterior or lateral vertebral displacement
• traumatic anterior spondylolisthesis
8. Denis classification
• A relevant injury to the middle column was therefore the
essential criterion for instability
• MINOR
– articular, transverse, and spinous processes as well as the pars-
interarticularis fractures.
• MAJOR
– compression fractures, burst fractures, flexion-distraction (seat-
belt) injuries, and fracture dislocations
9. AO CLASSIFICATION
• gold standard for documentation and treatment of injuries of
the vertebral spine.
• TWO COLUMN THEORY
– ANTERIOR: Vertebral body and the intervertebral discs
– POSTERIOR: pedicles, laminae, facet joints, and the PLL complex,
10.
11. • TYPE A: COMPRESSION INJURIES
– compression by axial loading (e.g., compression and burst
fractures).
• TYPE B: DISTRACTION INJURIES
– flexion-distraction or hyperextension injuries and involve
the anterior and posterior column.
• TYPE C: ROTATIONAL INJURIES
– Compression or flexion/distraction force in combination
with a rotational force in the horizontal plane (e.g.,
fracture dislocations with a rotatory component)
12.
13.
14.
15. AO CLASSIFICATION
• STABLE :
– Fractures with no injury to ligaments or discs pure impaction fractures
(Type A1)
• SLIGHTLY UNSTABLE :
– fractures with partial damage of ligaments and intervertebral discs the so-
called incomplete superior burst fracture type (A3).
• HIGHLY UNSTABLE:
– severe damage of the ligaments and intervertebral discs, as it occurs in
the fracture Types A3, B, and C.
16. Clinical Presentation
• Three major objectives to identify:
– The spinal injury:
• About 30% of polytrauma patients have a spinal injuries
– Neurological deficits:
• done according to the guidelines of the American Spinal Injury
Association (ASIA scoring)
– Concomitant non-spinal injuries:
• head injuries (26%)
• chest injuries (24%)
• long bone injuries (23%)
17. HISTORY
• The cardinal symptoms are:
– pain
– loss of function (inability to move)
– sensorimotor deficit
– bowel and bladder dysfunction
• The history should include a detailed assessment of the injury, i.e.:
– type of trauma (high vs. low energy)
– mechanism of injury (compression, flexion/distraction, hyperextension,
rotation, shear injury)
19. • fractures at the thoracolumbar junction may result in
– distal spinal cord with complete/incomplete paraplegia
– conus medullaris with malfunction of the vegetative
system
– cauda equina
– thoracolumbar nerve roots.
20. • Damage to parasympathic centers located in the conus medullaris
– bladder dysfunction,
– bowel dysfunction and
– sexual dysfunction.
• In the case of cauda equina or in a combination with damage to
the conus medullaris
– lower extremity paresthesia,
– weakness and loss of reflexes is found.
21. IMAGING STUDIES
• Standard radiographs
– anterior-posterior and lateral radiographs of the entire
spine are standard imaging studies after a spinal trauma.
– Radiographs taken with the patient in the prone position
underestimate the extent of kyphotic deformity.
– emergency radiographs often do not suffice becauseof
their poor quality
22. Following features should be
investigated:
• ANTERIO-POSTERIOR VIEW (AP VIEW)
– loss of lateral vertebral body height (i.e., scoliotic deformity).
– changes in horizontal and vertical interpedicular distance.
– asymmetry of the posterior structures
– luxation of costotransverse articulations
– perpendicular or oblique fractures of the dorsal elements
– irregular distance between the spinous processes (equivocal sign)
• IN LATERAL VIEW
– sagittal profile
– degree of vertebral body compression
– interruption or bulging of the posterior line of the vertebral body
dislocation of a dorsoapical fragment
– height of the intervertebral space
23.
24. COMPUTED TOMOGRAPHY
• has a better sensitivity and specificity compared to standard
radiographs,
• The axial view allows an accurate assessment of the
comminution of the fracture and dislocation of fragments into
the spinal canal
• Sagittal and coronal 2D or 3D reconstructions are helpful for
determining the fracture pattern.
25.
26. MAGNETIC RESONANCE IMAGING
• In presence of neurological deficits, for possible
– cord lesion or a cord compression due to disc or fracture
fragments or to
– epidural hematoma
• In the absence of neurological deficits,
– MRI can be helpful in determining the integrity of the posterior
ligamentous structures and thereby differentiate between a
Type A and an unstableType B lesion.
– For this purpose a fluid sensitive sequence (e.g., STIR) is
frequently used to determine edema
27.
28. GENERAL OBJECTIVES OF TREATMENT
• RESTORATION OF SPINAL ALIGNMENT
• PRESERVATION OR IMPROVEMENT OF
NEUROLOGICAL FUNCTION
• RESTORATION OF SPINAL STABILITY
• AVOIDANCE OF COLLATERAL DAMAGE
29. NON OPERATIVE TREAMENT
• The main advantage of non-operative treatment is the
avoidance of surgery related complications. such as:
• infection
• iatrogenic neurological injury
• failure of instrumentation
• anesthesia-related complications
30. Indications for non-operative
treatment
• pure osseous lesions
• absence of malalignment
• absence of neurological deficits
• absence of gross bony destruction
• only mild to moderate pain on mobilization
• absence of osteopenia/osteoporosis
31. Non-operative Treatment Modalities
• three different methods of non-operative
treatment:
– repositioning and cast stabilization
– functional treatment and bracing without
repositioning
– functional treatment without bracing
32.
33. Operative Treatment
• For unstable fractures mostly because surgical
stabilizing allows for:
– early mobilization of the patient
– diminished pain
– facilitated nursing care (polytraumatized patients)
– earlier return to work
– avoidance of late neurological complications
34. Indications for surgical treatment
ABSOLUTE
• incomplete paraparesis
• progressive neurological
deficit )
• spinal cord compression
w/o neurological deficit
• fracture dislocation )
• severe segmental kyphosis
(>30°) )
• predominant ligamentous
injuries.
RELATIVE
• pure osseous lesions
• desire for early return to
regular activities
• avoidance of secondary
kyphosis.
• concomitant injuries
(thoracic, cerebral)
• facilitating nursing in
paraplegic patients
35. SPINAL CORD DECOMPRESSION
• The severity of a spinal cord injury is related to the force and
duration of compression, the displacement and the kinetic
energy.
• compression of the cord is an important contributing cause of
neurological dysfunction
• early decompression (<12 h) can beperformed safely and may
improve neurological outcomes
• Decompression of incomplete spinal cord lesions with
persistent compression is generally recommended.
• Early decompression of progressive neurological deficits is
indicated
36. SURGICAL TECHNIQUES
• Posterior Approach
– Posterior Monosegmental Reduction and
Stabilization
– Posterior Bisegmental Reduction and
Stabilization
– Posterior Reduction and Multisegmental
Stabilization
37. Posterior Monosegmental Reduction and
Stabilization
• Indication :
– feasible in selected Type A and B fractures
– only in incomplete burst fractures with intact
pedicles
• Contraindications
– broken pedicles and
– complete burst fractures of the body
38.
39. Posterior Bisegmental Reduction and
Stabilization
• remains the gold standard “working horse” for the vast
majority of thoracolumbar fractures.
• allows a secure fixation of the pedicle screws in the intact
vertebra one level above and below the fracture
• this construct, achieves reliably a good reduction and stable
fixation.
40.
41. Posterior Reduction and Multisegmental
Stabilization
• Fracture dislocations usually require multilevel spinal
stabilization
• for the very unstable thoracolumbar luxation fractures (Type C
lesions) which usually cannot be accurately reduced and
stabilized with a short two-level construct.
42.
43. Anterior Approach
• Type A fractures can be treated by an anterior approach alone
• anterior fusion and instrumentation for thoracolumbar burst
fractures may present fewer complications or additional
surgeries.
• Primary Indications
– insufficient spinal decompression
– insufficient anterior column restoration
44. Minimally Invasive Approach
• Has the benefit of reducing
– postoperative pain,
– shortening hospitalization,
– leading to early recovery of function and reducing
the morbidity of the operative approach
45.
46. Treatment Guidelines
• Type A1 fractures are usually treated conservatively
• Type A2 fractures can be treated conservatively
• Pincer fractures are prone to non-union and are better
treated surgically
47. A3 type fractures particularly the
incomplete burst fracture
• The treatment options depend on
the
– comminution of the vertebral
body, the
– degree of kyphosis, and the
presence or absence of
neurology.
• the accepted
treatments
– bracing to combined
anterior/posterior approach
all with acceptable results
48. • Type A4, type B and Type C are treated with surgical
stabization.
• Posterior with or without anterior approach