Fracture of Pelvis and Spine

Fracture pelvis and spine

Pelvic Fractures

• Pelvic fracture is a high energy trauma , as a result of MVA, fall .

• Classifications. ( Tile)

Type A. Stable

A 1. fractures of the pelvic not involving the Ring.

A 2 . Stable , minimally displaced fracture of the Ring .

• Type B. Rotationally Unstable ,Vertically Stable.

B1. Open Book

B2 . Lateral Compression : Ipsilateral

B3. Lateral Compression :Contra lateral

• Type C. Rotationally and Vertically Unstable

C1 . Unilateral

C2 . Bilateral

C3 . Associated with Acetabular Fracture

MANEGEMENT• Aggressive treatment .

• Obtain X-Ray: AP pelvic, Inlet ,outlet ,Ct Scan.

Treatment

• Aggressive treatment . By A.B.C.D.

• Obtain X-Ray: AP pelvic, Inlet ,outlet

• Ct Scan.

• Think in systemic approach.

• Specific treatment:

type A . symptomatic treatment

type B .ORIF with plates& screws ,External Fix.

Type C . ORIF with plates & screws. Both AP.

Acetabular fracture

• Usually it is a result of high- energy trauma .

• The acetabulum is divided into four segments—an anterior column and wall (rim) and a posterior column and wall (rim). . Fractures of the acetabulum are classified based on their involvement of these structures .

classification Letournel and Judet

Fractures of the Spine

Stability of vertebrae is maintained by :

♥ strong ligaments :

- ant. & post. longitudinal lig.

- interspinus ,supraspinus lig.,

and ligamentum flavum

♥ articular facets :

- vertical in D – L vertebrae

- horizontal in Cx vertebrae.

♥ Intervertebral discs.

Types of fracture spine

♥ stable fr. : - wedge fr.

- comminuted fr.

♥ unstable fr. : - fr. dislocation.

Usually caused by :

- hyper flexion injury,

- vertical compression,

- rarely hyper-extension .

Wedge fracture L 2

Complications

♥ in unstable fr.- dislocations, complete trans-sectionof the cord may occur, leading to permanentparaplegia, with its dangerous complications ofprolonged bed recumbency .

♥ PARAPLEGIA ..

due to damage or compression ofthe spinal cord.

Treatment

♥ 1st. aid : patient transferred

with max. care to prevent

cord injury.

♥ Stable fr. : bed rest, then

back support brace.

♥ Unstable fr. : O.R.I.F. + cord

decompression.

Injuries of the cervical spine

♥ pure dislocation may occur

without fracture, due to

horizontal position of

articular facets.

Hyper- extension injury of C2 – C3

( Hanging )