Regional adult trauma- Spinal Fractures

Question 1

What is the criteria to ‘clinically clear’ a c-spine injury in a conscious and co-operative patient?

Answer 1

• no hx of LOC
• GCS 15 with no EtOH
• no sig. distracting injury
• no neuro s/s in upper/lower limb
• no midline tenderness on palpation of c-spine
• no pain on gentle active neck movement (gentle forward flexion, rotate to each side)

Question 2

How do you radiologically clear a c-spine?

Answer 2

• x-ray (AP + lateral views +/0 odontoid peg open mouth)

- CT scan of C-spine

Question 3

How do you neurologically examine c-spine injury?

Answer 3

after a full trauma (ABCD) assessment:

• peripheral motor function
• coarse touch sensation
• upper and lower limb reflexes
• cranial nerve evaluation
• rectal examination
• assessement of bulbocavernous reflex

Question 4

Why are high c-spine # or dislocations abouve C3 sometimes fatal?

Answer 4

They are above C3- phrenic nerve is C3/4/5 that supplies diaphragm

Question 5

How do you treat stable c-spine injuries?

Answer 5

Firm cervical collar

Question 6

How do you treat unstable c-spine injuries?

Answer 6

Immobilization with halo vest

• surgical stabilization with fusions, wiring, or internal fixation
• subluxations and dislocations may require traction for reduction, halo application, or sx stabilisation
• burst fractures with neuro deficit- traction to decompress spinal canal

Question 7

Indications for sx in thoracolumbar spinal fractures

Answer 7

• presence of neuro deficit (esp if prog. or very unstable)
• unstable injury patter with substantial loss of vertebral height, displacement or invol. of posteroir ligamentous structures

Question 8

Sx for thoracolumbar spinal fractures

Answer 8

• stabilization with pedicle screws and rods
• spinal fusion
• decompression in presence of neurologic deficit