FRACTURE OF COLLUMNA

VERTEBRALIS
Dr. JOHAN BASTIAN SpOT
Orthopaedic dan Traumatologi
RSUD KANJURUHAN KEPANJEN
Since 2500 SM
USA 1500 case/year
50% road traffic accident, 40% fall
from height,
10% sport injury
Vertebral Column :
7 cervical
12 thoracal
5 lumbar
5 sacrum and 5 coccsigeus
%
History
Preinjury Neurologic Status
Mechanism of Injury
Changes in Neurologic Status
Document
Vertebral Assessment
Pain
Tenderness
Deformity
Edema, ecchymosis
Muscle Spasm
Tracheal Deviation, Hematoma
Assessment
Neutral position, totally immobilized
A,B,C
Injury maybe masked
Roentgenogram
Document
Early neurosurgical orthopedic
consultation
Spinal Injury
Prevent further injury
Presume present of injury until excluded
Management
Immobilized until excluded
Intravenous fluids
diuretic, steroid
Transfer
Management
Intravenous Fluids
Treat hypovolemia first
Consider neurogenic shock
Urinary catheter

Medication
Diuretics
Steroids
consult
neurosurgeon
Management
Transfer
After neurosurgical orthopedic consult
Unstable fracture
Neurologic deficit
Avoid delay
Properly immobilized
Respiratory support as needed

Management
Suspect Cervical Spine Injury
supraclavicular injury
Head injury with/without loss of
consciousness
Radiographic
Guidelines
AP diameter of canal
Contour/alignment vertebra
Bone fragment displacement
Fracture
Soft tissue swelling

Lateral C-spine film
Adequate C-spine film Inadequate C-spine film
Cervical Strain (whiplash)
Soft tissue injury due to sudden
hyperextension
Anterior longitudinal ligament and iv
disc tear

Atlas Fracture (C1)
Involve a blow out of the ring C1
---> fracture Jefferson
Seen best on open mouth view of
C1 and C2 area
Bilateral Jefferson
fracture (C-1
Atlas)
Axis Fracture (C2)
Odontoid Fracture
Above the base of adontoid (type 1), at
the base (type 2) and extends into the
vertebral body (type 3).
posterior element fracture of C2
---> the fracture Hangman
Hangmans fracture
Fracture Dislocation C3 - C7
Mechanism of injury; flexion axial
loading, extension axial loading, or
flexion rotation injury
Level C5 most common site of
fracture
C5-C6 most common dislocation
Suspect Spine Injury
cervical, thoracal, lumbar
High speed crash
Multiple trauma
Symmetry of pedicle
Height of the disc spaces
Alignment of. spinous Proc
Shape/contour of vertebral
bodies
Thoracic and lumbar spine
Radiographic Guidelines
Vertebral Thoracal Fracture
Mechanism of injury; wedge
compression, burst fracture, fracture
dislocation
Stable and unstable
Cause by fall from height
Vertebral Lumbar Fracture
More mobility than thoracal vertebra
Trauma Jack-knife ---> seat belt injury -
--> Chance Fracture
Wedge compression fracture
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