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MULTIPLE TRAUMA ASSOCIATED WITH SPINAL INJURY

Destriyanti Rukmana Sari

INTRODUCTION
Multiple trauma patients with severe spinal cord injuries have a high mortality rate and survivors can face significant long-term disability1 with poor outcome. What is the aims?

PATIENT AND METHODS


November 2006 to October 2009 Queen Elizabeth National Spinal Cord Injuries Centre 375 patients 150 patients with and without neurological damage From medical record and radiological investigations : age, gender, mechanism injury, vertebral level and neurological degree of spinal injury and assosiated injuries

RESULTS
1.

2.
3.

There were 93 males and 57 females The age group ranged from 16-78 years (mean 37 yo) Mechanism or etiology of spinal injuries
Etiology of spinal injuries Road traffic accident Fall from height Fall from stairs Sporting injuries Assaults Number 56 36 19 18 12 Percentage 37.4% 24% 12.6% 12% 8%

Cycling accidents
Suicide attempts

6
3

4%
2%

4. Associated injuries with spinal cord injuries


Associated Injuries
Chest injury Abdominal injury Limb injury Head injury Facial injury Total

Cervical Spine
8 (12.5%) 6 (9.4%) 13 (20.3%) 19 (29.7%) 18 (28.1%) 64

Lumbal Spine
11 (26.2%) 14 (33.3%) 9 (21.4%) 5 (11.9%) 3 (7.2%) 42

Thoracic Spine
17 (44.7%) 10 (26.3%) 8 (21.1%) 1 (2.6%) 2 (5.3%) 38

Sacral Spine
0 4 (66.7%) 2 (33.3%) 0 0 6

Totals

36 (24%) 34 (22.7%) 32 (21.3%) 25 (16.7%) 23 (15.3%) 150

44.7% of patients with thoracic spinal injuries had severe chest injuries that included multiple rib fracture, hemothorax, pneumothorax, lung injury, and injuries to the heart and great vessels.

5. Pattern of spinal cord injuries

The most common level of injury was C5-C6 fracture dislocation.

CONCLUSION
There is a close relationship between spine and associated injuries. Therefore, a high index of suspicion is required to rule out associated injuries in spine trauma and vice versa. Acute spinal injury victims require prompt assessment and resuscitation and they should be admitted in a centre with all the resources and trained personnel to recognize and treat their associated problems.

WE MUST KNOW ..
Multiple Trauma is the condition of a person who has been subjected to multiple traumatic injuries, such as a serious head injury in addition to a serious burn. Spinal cord injury (SCI) is an insult to the spinal cord resulting in a change, either temporary or permanent, in its normal motor, sensory, or autonomic function. Primary survey Airway with cervical spinal control, Breathing and keep ventilation, Circulation with control haemoragic, Disability. Exposure/Environment control

ASIA IMPAIRMENT SCALE


ASIA American Spinal Injury Associations 5 grades : A Complete. No motor or sensory function in the lowest sacral segment (S4-S5) B Incomplete. Sensory function below neurologic level and in S4-S5, no motor function below neurological level C Incomplete. Motor function is preserved below neurological level and more than half of the key muscle groups below neurologic level have a muscle grade less than 3 D Incomplete. Motor function is preserved below neurologic level and at least half of the key muscle groups below neurologic level have a muscle grade 3 or more E Normal. Sensory and motor function is normal

Thank you for your attention