TRAUMAS OF SPINE AND PELVIS.

Done by :Moldir Akynbay 17-40-01

DAMAGE TO THE SPINE AND
PELVIS
SPINE FRACTURES
 Fractures are accompanied by
concussion, bruising, compression,
or a break in the spinal cord. With
direct trauma, bruises, fractures of
the transverse and spinous
processes are possible.
Compression by earth, stones,
falling from a height to feet,
diving in a shallow place lead to a
fracture of the vertebral bodies and
arches.

Spine sections: 1 - cervical; 2 -

chest; 3 - lumbar; 4 - sacral; 5 -
coccygeal.
 Diver's injury

 The vertebrae, like other bones in

our body, normally have a
significant margin of safety and
can withstand significant loads.
However, when an external force
is applied that exceeds the
strength of the vertebra, the
integrity of its bone structure is
violated, that is, a fracture occurs.
Fractures of the vertebrae in
young and middle-aged people
often occur when exposed to a
very significant external force.
The most common causes of
spinal fractures in this category
of people are car accidents,
"diver's injury" and falls from
great heights.

Car accidents
 COMPRESSION FRACTURE
 If during a fracture there is a decrease in the
height of the vertebral body, then such a
fracture is called a compression fracture. This
type of spinal fracture occurs most frequently.
Quite often, bone fractures, including
vertebrae, occur with a decrease in bone
density. This disease is calledosteoporosisand is
most common in older women. Thus, 40% of
women over 80 years of age have a
compression fracture of the spine at least once
in their life. Most often, these fractures go
unrecognized, but they can cause progressive
deformities of the spine ("senile hump"), as
well as persistent back pain. In osteoporosis,
very little force (for example, falling from a
chair) is sufficient to cause a vertebral fracture.

Compression fracture of
the spine
SHRINKED FRACTURES
 Another type of vertebral fracture
is comminuted fractures. The most
severe type of comminuted
fractures is an explosive fracture
of the vertebra, in which the
vertebral body splits into several
fragments and in many cases loses
its connection with the posterior
structures of the vertebra. An
explosive fracture is an extremely
unstable fracture, therefore, its
presence is an indication for
surgical intervention.

Explosive fracture
SYMPTOMS OF SPINE Fracture
 Ifthe fracture is caused by a significant external
force, then at the time of injury, patients
experience severe back pain. In some cases, the
pain may radiate (give) to the arms or legs.
When nerve structures are damaged, weakness
and numbness occur in the upper or lower
extremities.
 A fracture of pathologically altered vertebrae
that occurs with minor trauma may be
accompanied by only minor back pain.
 Fractures of the residual spines

 They occur more often in the

cervical region from a direct blow
from behind, with overextension of
the spine or excessive contraction of
the long back muscles. At the site of
damage, swelling, pain with
pressure, displacement of the
appendix and crepitus are noted.
The diagnosis is clarified by X-
ray.Treatment. Anesthesia of the
fracture site (10 ml of 1% novocaine
solution). If the fragment causes
pain, it is removed.

Fracture of the spinous process

of the VII cervical vertebra with a
characteristic displacement
 Fractures of the transverse branches
 They occur with trauma or sharp muscle
tension in the lumbar spine. The clinical
picture is characterized by soreness in the
lumbar region with irradiation of pain in
the abdomen and lower extremities. The
diagnosis is confirmed by radiography.
Treatment consists in anesthesia of the
fracture site (10 ml of 1% novocaine
solution), which is repeated for several
days. Physiotherapy and massage are also
prescribed. Bed rest is recommended to
be observed until the pain disappears.
Ability to work is restored after 3-6
weeks.

5-transverse process III lumbar

vertebra
SPINAL CORD DAMAGE

Spine and
segmental
division of the
spinal cord
 When the spinal cord is damaged, paralysis and cuts occur, as
well as urinary and defecation disorders. Sensitivity is
impaired, severe trophic disorders develop, bedsores on the
sacrum, heels, back. Sometimes the spinal cord injury is
reversible and resolves 10-15 days after the elimination of the
edema or hematoma.
IMPORTANT!!!
 Fractures of the vertebral bodies are often accompanied by hemorrhages in the
retroperitoneal tissue and a cut in the intestine. Sometimes, when the intestine is cut,
a laparotomy is done in connection with suspected damage to the abdominal organs.
When a vertebra is fractured, death from traumatic shock, hypostatic pneumonia,
sepsis can occur. The diagnosis is confirmed by x-ray of the spine in the anterior and
lateral projections. In case of doubtful data, the picture is repeated after a few days.

X-ray (spinal
fracture with a
violation of the
integrity of the
spinal cord
TREATMENT.
 Transportation: Transportation of
victims with suspected spinal fractures
is possible on an ordinary soft
stretcher in the prone position with a
soft roller placed under the shoulders,
or on the back on a hard shield that is
placed on the stretcher. In case of
fractures of the cervical vertebrae, a
special collar is applied, which in the
form of a frame covers the cervical
spine. Transferring the patient to a
stretcher and removing from them
should be extremely careful so as not
to displace the fragments and cause
compression of the spinal cord.
HOSPITAL TREATMENT
 In the hospital, after the diagnosis is established,
anesthesia the body of the damaged vertebra (inject no
more than 10 ml. 1% solution of novocaine). The needle
is carefully advanced to the anterior surface of the
vertebra, after which a solution of novocaine is injected.
In case of vertebral body fractures, traction is performed
on an inclined plane with gradual reclination (deformity
correction) of the damaged vertebra. When the patient
begins to walk, a plaster corset is applied for
immobilization. Constant exercise therapy allows you to
create a "muscle corset". Fusion of the vertebral body
occurs within 2 to 4 months.
PELVIC DAMAGE
 Pelvic fractures are the result of severe
transport or work injuries, therefore they
are more common in men aged 40 years.
Fractures of the pelvis occur when it is
squeezed in the anteroposterior or lateral
direction. Possible marginal fractures of
protruding bones, such as the ilium, and
fractures without disrupting and disrupting
the continuity of the pelvic ring. Most
often, the pubic and ischial bones are
broken, the ilio-sacral joint is torn.
Fractures of the acetabulum with a tearing
edge or a fracture of the bottom with central
dislocation can also be observed.
 During childbirth, the
symphysis ruptures. With
complicated fractures, damage
to the urinary tract (bladder,
urethra), rectum, blood vessels
and nerve trunks is noted. With
the growth of vehicles, the
number of complicated
fractures with severe shock
increases. With gunshot
wounds to the pelvis, open
fractures occur with damage to
the pelvic organs.
Multiple pelvic fractures in patient
K… 25 years old.
 Clinics
 Victims complain about:
 pain in the corresponding parts of the
pelvis
 On examination: in patients with
violation of the integrity of the pelvic
ring, pelvic deformity, limitation of
movement in the limbs are revealed. For a
fracture of the pubic bones, a symptom of
a stuck heel is characteristic: the victim is
unable to tear the heel off the bed, but if
he lifts his leg, he holds it without
assistance.
 With a fracture of the anterior
pelvic ring, the frog symptom
occurs, in which the knees are
bent and apart. Shortening of the
limb is noted with a fracture of the
bottom of the acetabulum and a
central dislocation. Sometimes
bruising is visible in the area of ​
the fracture. On palpation, pain in
the area of ​the fracture, crepitus,
pathological mobility are
determined. On palpation through
the rectum or vagina, bone
fragments (fractures of the
sacrum, tailbone, ischial bones)
are felt.
DISPLACEMENT OF BONE
FRAGMENTS
 especially with vertical
fractures, is determined by
measuring on both sides of
the distance from the
superior axis of the ilium to
the inner ankle. Finally, the
diagnosis is clarified
according to the X-ray of the
pelvis.
Consequences of a pelvic injury
 DAMAGE TO THE URINARY TRACT
 damage occurs mainly with damage
to the anterior parts of the pelvis,
with ruptures of the symphysis. In
30% of cases, damage to the bladder
and 70% of the urethra is observed.
Clinic. When the urethra ruptures,
urination is delayed, a small amount
of blood is released from the urethra.
The bladder is distended and
protrudes above the pubis. In the
perineal region, tissue infiltration is
determined due to hemorrhage and
urine soak.
Fractures of the pelvic bones. a)
b) without violation of the pelvic
ring c) with violation of the pelvic
ring
RECTAL DAMAGE
 When the extra-abdominal
parts of the rectum rupture,
the excretion of feces is
disturbed, severe fecal
phlegmon of the pelvic
tissue occurs, the condition
of the patients is extremely
serious. A digital
examination of the rectum
with suspicion of pelvic
fractures is mandatory.
LENIE
 A victim with a fracture of the pelvic bones is transported to the
trauma department on a rigid stretcher in the supine position. A
roller (greatcoat, blanket) is placed under the limbs bent at the knee
joints. In case of sacrum fractures, the patient is transported in the
prone position. To prevent shock, intrapelvic anesthesia is
performed according to Shkolnikov. The needle is inserted under the
upper axis of the ilium and gradually advanced towards the sacrum,
constantly injecting novocaine. In case of unilateral damage, up to
500 ml of 0.25% solution of novocaine is injected, with bilateral
damage - about 300 ml on each side. With pelvic fractures,
significant bleeding into the retroperitoneal tissue (up to 2 liters) is
possible. Retroperitoneal hematomas may be accompanied by a
picture of severe intestinal paresis. In these cases, the intestines are
stimulated with drugs. Therapeutic measures are determined by the
nature of the fracture. Repeated blood transfusions are indicated for
anemia.
FOR PELVIC RING FRACTURES
WITHOUT DISPLACEMENT
 the patient is put to bed in
the "frog" position, the lower
limbs are placed on the
splint. They are allowed to
walk after 4 weeks, the
ability to work is restored
after 2 months.
FOR PELVIC RING FRACTURES WITH
DISPLACEMENT OF FRAGMENTS
 reduction is carried out due to
skeletal traction. It is applied to the
tuberosity of the tibia. The pelvic
end of the bed is raised, the leg on
the splint is removed. The size of
the load depends on the degree of
displacement, muscle development
and the speed of reposition of the
fragments and does not exceed 8
kg. Skeletal traction lasts up to 30
days, walking is allowed after 45
days, work capacity is restored
after 3 months.

Fracture of the pelvic ring with

displacement of bone fragments
 Therapeutic gymnastics is shown,
and after the disappearance of the
phenomena - massage of the
muscles of the buttocks, back,
thighs. Surgical treatment is
necessary for rupture of the
symphysis and central dislocation
of the hip, when conservative
measures fail to achieve a result.
Emergency operations are
performed if there is a suspicion of
damage to the abdominal organs,
rupture of the bladder and urethra.
THANKS FOR
ATTENTION !