Compression Fractures of the Spine – Injuries and Poisoning

• Resumption of normal activities (particularly walking) as soon as possible

• Sometimes a procedure, such as vertebroplasty or surgery

• Encouraging people to start moving as soon as possible

• Enabling people to function normally

• Preventing other fractures

Most compression fractures heal on their own, although slowly.

Pain relievers (analgesics), such as acetaminophen, can relieve pain. Occasionally, when the pain is severe, doctors prescribe opioid pain relievers.

If fractures occur in the lower spine, wearing a brace is sometimes recommended to relieve pain and make walking less painful. How effective bracing is unclear.

Sometimes bed rest is needed for a few days. However, people are encouraged to sit up and walk for short periods and to resume normal activities as soon as possible. Doing so helps prevent loss of muscle tone and additional loss of bone density.

Physical therapists can help by teaching people how to lift correctly and teaching them exercises to strengthen muscles around the spine, but therapy may need to be delayed until the pain is controlled.

Two minimally invasive procedures can sometimes be done to help relieve pain and possibly restore height and improve appearance:

• Vertebroplasty: After injecting a local anesthetic near the fractured back bone, doctors inject an acrylic bone cement into the collapsed back bone. The cement hardens in about 2 hours and stabilizes the back bone. This procedure takes about an hour for each back bone. People can go home the same day.

• Kyphoplasty: In this similar procedure, a balloon is inserted into the back bone and is expanded to restore the bone to its normal shape. Then bone cement is injected.

If a fracture is putting pressure on the spinal cord, surgery is done to relieve the pressure within hours if possible. Prompt treatment is needed to prevent permanent injury to the spinal cord.

Trauma (fractures, dislocations, instability) Symptoms and Treatments

Trauma to the spinal column may be caused by a number of events. The most common causes are motor vehicle accidents and falls.

Soft-tissue injuries such as ‘whiplash’ are also common.

Fractures and dislocations may occur throughout the spine, but are particularly common in the neck (cervical) and thoracolumbar (mid-lower back) regions. In severe cases, the spinal cord may be damaged, leading to paralysis.

From a neurosurgical perspective, spinal trauma is classified as ‘stable’ or ‘unstable’. Unstable fractures need to be treated more aggressively in order to avoid the development of spinal cord injury and paralysis. This treatment often requires surgery, but sometimes involves the use of traction and/or an external brace.

WHAT IS WHIPLASH?

Whiplash is a neck injury caused by a strain, sprain, or tear in the soft tissues (muscles and ligaments). It is caused by a sudden and severe neck movement.

The most common form of injury is a rear-end motor vehicle accident, where the head and neck rapidly bend a long way forward before stopping suddenly or even being thrown backwards.

Approximately 20% of people involved in rear-end motor vehicle accidents experience neck symptoms later. It is common to find that these symptoms are worse a day after the injury. Although most recover quickly, some develop chronic severe pain that may result in significant disability.

The term “whiplash” is best used to describe the way the injury occurred, although some use it as a diagnosis. The actual cause of symptoms can be either a stretch or tear of the ligaments or muscles, or even compression of the spinal nerves.

SYMPTOMS

The symptoms of whiplash may include neck stiffness or reduced range of movement, neck pain, headaches, and even arm pain.

Pain at the back of the neck is often worse with movement, and frequently peaks one or two days after the injury before improving. Muscle spasms and pain between the shoulder blades or over the trapezius muscles (between the shoulders and the neck) may also occur.

Headaches, especially at the back of the head (‘cervicogenic headaches’) are common.

Arm or hand pain, fatigue, numbness, tingling or weakness may be a result of nerve or spinal cord injury or compression. These symptoms usually warrant a more extensive investigation.

TREATMENT

Like sprains in other parts of the body, neck sprains usually heal gradually, with time and appropriate treatment.

COLLARS

A soft cervical collar may be worn for comfort. In cases where there is severe disc and/or ligamentous disruption, a hard collar (such as an Aspen Collar) may be prescribed.

MEDICATION

Analgesics and anti-inflammatory medications are often used to reduce pain and swelling. Muscle relaxants can be used to help ease muscle spasms. An ice pack may be applied for 15-30 minutes, several times a day for the first two or three days after the injury. Heat can help relax cramped muscles, but should not be applied for the first few days. Other treatment options include massaging the tender area, ultrasound, and physiotherapy.

MODIFYING ACTIVITIES

Early return to work is encouraged, usually with modifications in your workplace activities, which can be eased with time and recovery. Aerobic activities, such as walking or swimming, should be started early.
Whilst most symptoms resolve in one or two months, severe injuries may take several months to heal completely. Symptoms of arm weakness, numbness, or shooting pains should be investigated further.

SURGERY

Neck sprains or strains rarely require surgery. Indications for surgery include spinal cord compression, prolonged arm pain and/or weakness, and severe persistent headaches. Surgery may be recommended if other conditions such as verterbral fracture or disc herniation are present.

WHAT ARE COMPRESSION FRACTURES?

A vertebral compression fracture is where a bone in the spine collapses. These fractures occur most commonly in the thoracic spine (the middle portion of the spine) and upper lumbar (the lower portion of the spine) regions. The lower vertebra of the thoracic spine (T11 and T12) and the first vertebra of the lumbar spine (L1) are most prone to these types of fractures, which are therefore termed ‘thoracolumbar fractures’.

CAUSES

There are several causes of compression fractures. Whilst the bones (vertebrae) that make up your spine are usually very strong, they can fracture (break) in under certain conditions.

Vertebral fractures are often due to conditions such as osteoporosis (which weakens the bones, seen particularly in elderly women), significant falls, or excessive pressure from other trauma.

The most common cause is osteoporosis, a metabolic disease which thins the bones. The weakened bones can collapse during normal activity, such as bending forward, leading to a spinal compression fracture. Spinal compression fractures are the most common type of osteoporotic fractures, affecting nearly half of all women by the time they are 80 years old. These fractures can permanently alter the shape and strength of the spine. Osteoporotic fractures usually heal on their own and the pain disappears. Sometimes, however, the pain persists if the crushed bone fails to heal adequately. In severe osteoporotic fractures, a kyphosis or a “dowager’s hump” may result. This exaggeration of the normal curvature of the spine causes the shoulders to slump forward and the top of the back to look enlarged and humped.

Trauma to the spinal vertebrae can also lead to minor or severe fractures. Falls, forceful jumping, and motor vehicle accidents are frequent culprits.

Another cause of vertebral body fractures is metastatic disease involving the spine. ‘Metastasis’ refers to the spread of cancer cells into other regions of the body. The bones of the spine are a common place for many types of cancers to spread, with breast and prostate cancers being particularly common. A compression fracture of the spine that appears for no obvious reason may be the first indication of cancer spread to the spine. The cancer infiltrates and destroys of part of the vertebra, weakening the bone until it collapses.

SYMPTOMS

Pain is the most common symptom of a compression fracture, however significant pain is not always present.

If the fracture is caused by a major traumatic event, you will probably feel severe pain in your back, and sometimes also in your legs and arms. You might also feel weakness or numbness in these areas if the fracture injures the nerves of the spine or the spinal cord itself.

TREATMENT

Thoracic compression fractures are usually treated with a combination of pain medications, activity restriction and modification, and bracing. Vertebral body fractures usually take around three months to fully heal. X-rays are usually taken monthly to check on the healing progress and to ensure that progressive collapse of the vertebral body is not occurring.

Pain medications should reduce back pain, but will not help the fracture to heal. In osteoporotic patients, medications to improve bone density and slow bone loss may be prescribed to prevent further fractures.

RESTRICT NORMAL DAILY ACTIVITIES

You probably need to restrict your normal daily activities. You should avoid any strenuous activity or exercise. You must avoid heavy lifting and anything else that might place too much strain on your fractured spine. Otherwise the fractured bone may collapse further.

BRACES

External bracing is another common form of treatment for some types of vertebral compression fractures. The brace (orthosis) supports the back and restricts movement. It is designed specifically to prevent you from bending forward and placing added stress on the fractured bone.
In some cases, invasive treatment may also be necessary. These treatment options include:

1. Vertebroplasty: replacing the fractured bone with solid material to give it more strength
2. Kyphoplasty: using a small balloon to restore some of the lost height of the vertebral body and altered curvature of the spine
3. Spinal surgery

SURGERY

Surgery is not usually required for compression fractures. With vertebral fractures, surgery (‘internal fixation’) is only considered if there is evidence of serious instability of the spine.
Your neurosurgeon or spinal surgeon will usually recommend using some type of internal fixation to hold the spinal bones in correct position whilst the fractured bone heals. If there is pressure on the spinal cord, the bone fragments pushing into the spinal cord may also need to be removed, or a laminectomy performed to alleviate the pressure. Surgery may be performed via an anterior approach (from the front) or posterior approach (from the back).

In most cases, surgery to stabilize the fractured vertebra is performed through an incision in the back, also known as a posterior approach. Metal screws and rods are used to hold the vertebrae in the correct alignment while the fractured vertebra heals. The spinal cord and nerves are decompressed (if necessary) by this approach.

During an anterior approach an incision is made in the chest or abdomen. Bone fragments may be then be removed to relieve pressure on the spinal cord. A spine fusion is then performed by replacing the crushed vertebra with bone graft or a cage. Eventually, the vertebrae above and below are joined by a bridge of solid bone. During the surgery, a combination of metal screws, plates, rods and cages are inserted to hold the spine in the correct position to permit a solid fusion to occur over the next few months. These metal implants remain within the body and are not removed unless they cause problems.

Spinal Cord Fractures | Crush, Wedge, and Burst Fractures

September 27, 2016

Spinal fractures are common outcomes of many impact accidents, such as motor vehicle collisions, falls from heights, gunshots, or sports incidents.  The spinal cord is a complex bundle of nerves and vertebrae, responsible for delivering messages between the brain and the body. When the spine suffers a fracture or a break, it can have devastating consequences. There are several different types of fractures that can cause a serious spinal cord injury, here are the most common.

Wedge Fracture

Compression fractures occur mostly in the lower part of the back, in the thoracic or lumbar spine. The most common cause of a compression fracture is osteoporosis, but trauma can cause it as well. There are three types of compression fractures, and wedge fractures are the most common. When the spinal cord suffers a wedge fracture, the front of the vertebra collapses, but the back of the bone remains intact. This results in a wedge-shaped vertebra that is typically mechanically stable. This means the spine can still carry a person’s weight and function, but it can cause neurologic problems. If left untreated, wedge fractures can lead to spinal deformities such as hunchback.

Crush Fracture

In a crush fracture, the entire vertebra suffers a break, not just the front. The vertebra tends to collapse in on itself. Crush fractures are more severe than wedge fractures, although they are typically still mechanically stable. The victim will likely feel a sudden, sharp pain in the lower or middle back after a crush fracture injury. The pain can be debilitating for many spinal cord fractures.

Burst Fracture

Burst fractures may occur when extreme forces crush the vertebra. Burst fractures are the most serious form of compression fractures and are likely unstable. A mechanically unstable fracture can damage nerves and tissues during the break, causing spinal deformity and difficulty walking.

In a burst fracture, the vertebra collapses completely and bursts in multiple directions. This often sends small pieces of shattered bones into the tissues of the spine. This type of spinal cord injury requires immediate medical attention.

Flexion-Distraction Fracture

When a traumatic incident such as a car accident bends the spine in a way that places incredible stress on the vertebrae, it can result in a flexion-distraction fracture. The spine is capable of flexing forward, but sudden movement can break a vertebra or vertebrae. This type of fracture typically affects the posterior and middle column of the spine. If a flexion-distraction fracture occurs at the same time as a vertebral dislocation, the victim suffers a fracture-dislocation. This can involve all sections of the spinal column and result in an unstable fracture.

Signs of a Spinal Fracture

Depending on the severity of the spinal fracture, patients may not realize they’ve suffered a break right away. Knowing the signs of a spinal fracture will help you seek medical treatment sooner rather than later. A victim of an accident may notice severe back pain in the middle or lower spine. Pain can also exist in the sides or front of the spine. This pain can be intense and disabling, lasting weeks or months. In other cases, especially when osteoporosis causes fractures, the patient may experience:

• Back pain when walking but not when resting
• Loss of height over time
• Kyphosis, or stooped-over posture

Sometimes, the patient may experience difficulty walking, weakness, tingling, or numbness due to pressure on the spine from a compression fracture. It’s always best to visit a medical professional immediately after any type of traumatic accident to ensure you have not suffered a spinal fracture. The sooner you seek treatment for a spinal injury, the better your prognosis is likely to be.

Contact the Gomez Trial Attorneys team of San Diego spinal cord injury lawyers today for a free consultation.

Sources:

http://www.osteoporosis-health.com/conditions/osteoporosis/types-spinal-compression-fractures

http://www.mayfieldclinic.com/PE-SpineFract.HTM

http://www.emedicinehealth.com/vertebral_compression_fracture/article_em.htm

http://www.back.com/back-pain/conditions/spinal- fractures/

Posted in: Uncategorized

Types Of Spinal Compression Fractures And How They Are Treated: David Chang, MD-PhD, DABNS: Complex Spine Neurosurgeon

Spinal compression fractures occur when a vertebra breaks due to excessive compression or pressure on the bone. Since pressure can be applied in so many different areas and in a variety of ways in our spine, there are a number of different ways in which a compression fracture can occur. So today, we are going to look at the different types of compression fractures of the spine, and we’ll explain how each is cared for.

Types Of Spinal Compression Fractures

Before we dive into the specific types of fractures that can occur, we want to note that all of the following injuries can be classified as either a stable or unstable fracture. As you probably guessed, unstable fractures are more concerning than stable fractures, because unstable fractures involve bones that are likely to heal incorrectly, heal in such a way that it can affect nearby structures, or leave a person predisposed to a subsequent fracture. On the other hand, stable fractures are expected to heal correctly and aren’t likely to cause future problems in the spinal canal. So keep that in mind as we look at the different types of spinal compression fractures.

There are three common types of vertebral compression fractures – Burst fractures, Crush fractures and Wedge fractures. We’ll dive into those three below.

Burst Fractures – A burst fracture is typically the most problematic because during this type of fracture, the vertebra is overstressed and “bursts” out in many different directions. This can send pieces of bone into the nearby spinal tissues or into the spinal cord itself. Burst fractures aren’t likely to heal correctly on their own, and medical assistance is typically required right away to ensure any potential damage is contained. Surgery is typically required to fix burst fractures.

Crush Fractures – A crush fracture occurs when the fracture breaks through the entire vertebra, not just one section. When these fractures occur, the bone tends to collapse in on itself. While it sounds complex, crush fractures are typically stable, and as long as it is not threatening nearby structures, they can heal successfully without operating.

Wedge Fractures – A wedge fracture is the least serious and thankfully the most common type of compression fracture. This type of fracture occurs when the front of the vertebra collapses due to pressure, but the back of the bone remains intact, resulting in a wedge-like shape. Most wedge fractures are stable, but they should be regularly monitored because if they heal incorrectly, it can cause changes with your posture.

Treatment for any of these fractures depends on a number of different factors, including the type, location, stability and size of the fracture. Some of these fractures heal with rest and pain medications, while others may need multiple surgeries to ensure they heal correctly.

If you have injured your back and want a specialist to take a look at it, reach out to the experts at Midwest Spine & Brain Institute. Dr. Chang has a wealth of experience diagnosing and treating spinal conditions like fractures and disc issues, and he’s confident he can help get you back on the path to recovery. Contact his office today.

Vertebral Compression Fracture | UVA Health

What Is Vertebral Compression Fracture?

The bones of the back are called the vertebrae. A vertebral fracture is a break in one of these bones. A vertebral compression fracture occurs when the front part of the bone is squeezed or compressed.

Causes of Vertebral Compression Fractures

A vertebral compression fracture can be caused by:

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• Osteoporosis — a condition of weakened bones
• A blow to the back
• Falling down
• Landing on your heels when jumping from a height
• Having major trauma such as a motor vehicle accident

Risk Factor for Developing Vertebral Compression Fractures

Factors that increase your risk of vertebral compression fractures include:

• Osteoporosis
• Trauma
• Cancer
• Use of antipsychotic medications
• Proton pump inhibitors
• Poor mental functioning
• Poor mobility
• Poor strength
• Previous vertebral fracture within the last year

Vertebral Compression Fracture Symptoms

Symptoms may include:

• Mild to severe pain in the middle or lower back
• Numbness, tingling, or weakness
• Difficulty walking
• Loss of control of the bowel or bladder

Diagnosing Vertebral Compression Fracture

You will be asked about your symptoms and medical history. A physical exam will be done.

Images may be taken of your bodily structures. This can be done with:

• X-rays
• MRI scan
• CT scan
• Bone scan

You may be tested to determine if you have osteoporosis. This can be done with a bone mineral density test.

Vertebral Compression Fracture Treatment

Treatment includes:

Surgery

Vertebroplasty involves liquid cement being injected into the vertebra. It can help relieve the pain associated with vertebral fractures. The procedure may be best for recent fractures.

Talk with your doctor to see if this option may be right for you. For example, it may not be as helpful in people whose fractures are due to osteoporosis.

In kyphoplasty, doctors use a balloon to create a cavity. They then inject cement into the cavity. This procedure is designed to relieve pain. It can also improve spinal deformities from the fractures.

Spinal fusion may be used to join together two or more bones in the spine. This procedure stops the bones from moving.

Nonsurgical Treatments

Your doctor may advise:

• A brief period of bed rest and a decrease in activity
• Medication to control the pain
• Strengthening exercises for your back muscles
• A back brace

Treatment for Osteoporosis

Medications

To prevent further bone loss, medications may include:

• Estrogen/progesterone hormone replacement therapy
• Bisphosphonates to prevent loss of bone mass
• Estrogen agonist/antagonist to treat weak or thin bones
• Calcitonin to regulate calcium levels in the body
• Parathyroid hormone to regulate calcium and phosphate levels in the body

The following may also be advised:

• Vitamin and mineral supplements, especially calcium combined with vitamin D
• Lifestyle changes — These may include weight-bearing and resistance exercises for both the upper and lower extremities.

Preventing Vertebral Compression Fracture

Building strong bones will help prevent fractures. However, most bone strength is attained by women before they are 25 years old. That makes maintaining bone density and strength at older ages even more important.

Follow these prevention guidelines:

• Get plenty of weight-bearing exercise. This includes walking, jogging, or sports such as tennis.
• Do resistance exercises for arms and legs. This will help to improve your strength and balance.
• Get plenty of calcium, vitamin D, and protein in your diet. Talk to your doctor if you think you need supplements.
• If you have osteoporosis, you should talk to your doctor about treatment options. If you had an early menopause, talk to your doctor about this.
• If you smoke, talk to your doctor about ways to quit.
• Drink alcohol only in moderation. Moderate alcohol intake is two drinks per day for men and one drink per day for women.
• Remove any obstacles in your home that could cause you to fall. These may include throw rugs or furniture.

Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.

Compression Fracture – an overview

Vertebral compression fractures

Vertebral compression fractures are defined by a loss of more than 15% of normal vertebral body height. Osteoporosis is the most common cause of compression fractures and occurs most often in postmenopausal women. Additional causes include metastases, multiple myeloma, leukemia, lymphoma, malignant and benign primary vertebral neoplasms, trauma, osteomyelitis, osteomalacia, osteitis cystica, and hemochromatosis.

The World Health Organization defines osteoporosis as bone mineral density more than 2.5 standard deviations below the mean in a normal young adult population. Osteoporosis may be primary (associated with aging) or secondary to corticosteroids, hyperthyroidism, multiple myeloma, oophorectomy, male hypogonadism, paralysis, anticonvulsants, and alcoholism. Thirty percent of postmenopausal white women in the United States are estimated to have osteoporosis; this is associated with bone fragility and an increased risk of fractures. The cumulative lifetime risk of developing a symptomatic vertebral compression fracture is 16% in white women and 5% in white men.^69,70

The clinical presentation and course of osteoporotic compression fractures is quite varied. Although spine imaging often detects incidental, asymptomatic compression fractures in elderly people, painful compression fractures are quite common. It is estimated there more than 700 000 symptomatic osteoporotic compression fractures occur each year in the United States associated with 115 000 hospital admissions, 161 000 physician visits and five million days of restricted activity. ⁷¹ The pain associated with osteoporotic compression fractures usually lasts 2 weeks to 3 months, but may persist indefinitely and can significantly impair physical, functional, and psychosocial performance. Many compression fractures are associated with severe pain that is refractory to conventional forms of therapy such as immobilization, bracing, and analgesics. Patients commonly experience a profoundly negative impact on the quality of their lives, and potentially life-threatening secondary medical problems can develop such as deep venous thrombosis, pulmonary embolism, pneumonia, constipation, decubitus ulcers, and depression. Vertebral compression fractures associated with benign and malignant tumors also frequently cause severe pain and disability that is refractory to conventional therapies.

Percutaneous vertebroplasty is a relatively new and effective minimally invasive technique to treat painful compression fractures. The procedure was first performed in France in 1984; it consists of the percutaneous insertion of a relatively large-gauge bone needle into a vertebral body and the injection of a viscous liquid mixture of polymethyl methacrylate cement under fluoroscopic guidance. The procedure is usually performed for pain relief, but may also mechanically reinforce the pathologically weakened vertebra. Cement polymerization strengthens and stabilizes the vertebral body. Mechanical stabilization is thought be the primary mechanism for pain relief; however, neurotoxic effects from the methylmethacrylate monomer and heat from the exothermic polymerization reaction may also contribute by destroying nociceptive receptors and nerves. Vertebroplasty has successfully treated painful vertebral compression fractures caused by osteoporosis, hemangiomas, metastases, multiple myeloma, and lymphoma.⁷²

Patients are typically screened with plain films to identify the presence, number, and positions of the vertebral compression fractures. If there are serial examinations, the interval development of new compression fractures can be determined and correlated with the clinical history. MRI usually is obtained next, to obtain more information about the age and etiology of the compression fractures, and also to exclude other causes for the patient’s symptoms. CT and bone scans are obtained in selected cases to answer specific questions.

The MRI appearance of osteoporotic compression fractures varies with time. The bone marrow in a vertebra with an acute benign compression fracture has edema and inflammation that is dark on T1-weighted images and bright on STIR and T2-weighted images. This bone edema usually resolves in 4–6 weeks. The bone marrow signal intensity returns to normal with resolution of the bone edema and is bright on T1-weighted images reflecting fatty marrow.^73,74 This return to normal-appearing bone marrow is diagnostic of a benign cause and excludes a malignant compression fracture.

A malignant vertebral compression fracture is also dark on T1-weighted images and variably bright on T2-weighted images (Fig. 6.26). Unlike a benign compression fracture, the low signal intensity on T1-weighted images will only return to normal following radiation therapy. Benign and malignant compression fractures can look identical on MRI, and definitive diagnosis may require a biopsy; however, there are some distinguishing characteristics. As previously noted, the benign compression fracture marrow signal intensity usually returns to normal in about 6 weeks, while the malignant compression fracture marrow does not. A malignant compression fracture often has abnormal signal throughout the vertebra, and can have abnormal signal in the pedicles and the rest of the posterior elements. The abnormal signal in benign compression fractures usually does not involve the entire vertebral body or the posterior elements. Large paravertebral or epidural masses are common with malignant and uncommon with benign compression fractures.^73,74

Patients who are referred for vertebroplasty often have multiple osteoporotic compression fractures of indeterminate ages with nonlocalizing physical examinations. Identifying the compression fractures that are responsible for the pain that will respond to vertebroplasty can be difficult. The presence of increased uptake on a bone scan in an osteoporotic compression fracture is a good predictor for a positive clinical response to vertebroplasty. Of 27 patients with 35 osteoporotic compression fractures that demonstrated increased activity on bone scan, 93% had a significant decrease in pain following vertebroplasty.⁷⁵ All of the 14 patients evaluated for mobility had a significant improvement after vertebroplasty. The presence of bone edema on MRI can distinguish painful acute/subacute from asymptomatic chronic osteoporotic compression fractures and correlates with a clinical benefit from vertebroplasty.⁷⁶ The sagittal STIR pulse sequence detects bone edema with the greatest sensitivity. T2-weighted FSE images are almost as sensitive. MRI can also demonstrate the fluid-filled cavity within a vertebra seen in Kümmel’s disease (vertebral body osteonecrosis) (Fig. 6.27), which responds well to vertebroplasty.^77,78

Although CT is not used as commonly as plain films and MRI for the evaluation of vertebroplasty patients, it has roles. CT is useful to evaluate the integrity of the posterior bony cortex of a vertebra with a malignant compression fracture. Large regions of posterior cortical destruction (Fig. 6.28) increase the risk of cement extravasation causing spinal cord or nerve root compression and are associated with higher vertebroplasty complication rates. Such cortical destruction is rare in osteoporotic compression fractures and occurs more commonly in cases of malignant compression fractures due to metastases. If the CT demonstrates this type of destruction the vertebroplasty technique can be modified or the procedure might not be performed. CT is the most accurate method to evaluate the distribution of the polymethyl methacrylate cement after a vertebroplasty, especially important in a patient with a new radiculopathy or myelopathy that may be due to extravasated cement.⁷⁹

Spine Surgery | Vertebral Compression Fracture Treatment

Osteoporosis is a systemic skeletal disease characterized by compromised bone strength, which predisposes the affected bone to fracture. It is now recognized that both bone density and bone quality (architecture, turnover, damage and mineralization) are important determinants of bone strength. Osteoporosis can occur at any age and in both males and females. In the U.S. alone, osteoporosis causes 250,000 hip fractures, 250,000 wrist fractures and 700,000 – 750,000 vertebral fractures per year. ¹

The spine is made up of strong bones called vertebrae. A vertebra can break just like any other bone in the body. When the vertebral body collapses, it is called a vertebral compression fracture (VCF). These fractures happen most commonly in the thoracic spine (the middle portion of the spine), and lumbar spine (the lower part). Vertebral fractures are usually caused by osteoporosis. This condition can be caused by a diet lacking in calcium, excessive alcohol consumption, menopause, chronic steroid therapy, smoking, or as a normal consequence of aging. It is estimated that 1 in 3 women and 1 in 8 men over the age of 50 has osteoporosis – worldwide. Fractures, can result in pain and disability. ²

Vertebral compression fractures can have devastating long-term effects in terms of diminished quality of life, decreased independence, and increased morbidity and mortality. Focusing on the worst outcome of osteoporosis – death – the Fracture Intervention Trial, which followed more than 6,000 relatively healthy older women over approximately four years showed that both hip and clinical vertebral fractures were associated with significant increases in mortality. Increased mortality is one of many consequences of osteoporotic vertebral fractures; however, unlike hip fractures, only one-third of vertebral fractures receive clinical attention. Recent data shows that a single vertebral fracture increases the risk of further vertebral fractures and that each subsequent fracture can lead to increased morbidity and mortality. It is vital that progress be made in the timely diagnosis and treatment of this condition.

Interventional Neuroradiology doctors will order the appropriate imaging tests to see if you are indeed a candidate for a spine interventional procedure.

¹ National Institute of Health. Osteoporosis prevention, diagnosis, and therapy. Consensus Statement. Bethesda, MD: National Institutes of Health; 2000;17:1-36.

² Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D. Risk of mortality following clinical fractures. Osteoporosis Int. 2000;11:556-561

90,000 Types of spinal fractures

Spinal cord injuries range from relatively mild sprains of ligaments and muscles to fractures and dislocations of the vertebrae and spinal cord injuries, which is why they are so important. Its treatment also depends on the type of fracture and the degree of spinal instability. Therefore, familiarity with the types of vertebral fractures helps to choose the optimal treatment.

What are spinal fractures?

A spinal fracture or dislocation of one or more vertebrae in the spine is a severe orthopedic injury.Because the spine is directly connected to the spinal cord, and damage to the spinal cord can lead to paralysis or death. Spinal fractures can occur in the cervical, thoracic, or lumbar regions. Approximately 5-10% of these fractures occur in the neck, 64% in the thoracolumbar (lumbar) region, and often in the T12-L1 vertebrae.

Depending on the severity of the injury, the fracture has symptoms such as pain, difficulty walking, and inability to move the arms or legs. The most common sign of a spinal fracture is moderate to severe pain that gets worse with movement.

Treatment of spinal fractures depends on the type of fracture and the degree of spinal instability. Many fractures heal with conservative treatment. However, severe fractures may require surgery to restore the position of the vertebrae.

Acquaintance with the three-column division of the vertebral body

To classify the types of vertebral fractures, doctors divide them into three areas. This classification is known as the Dennis classification. In this method, the spine is divided into three parts: the posterior, middle and anterior, called the three-column vertebral division.

Front Column

This area is the front of your spine facing the front of your body and includes the front half of your vertebral body and the intervertebral disc. In the front of the spine, there is a ligament called the anterior longitudinal ligament, which is also part of the anterior column.

Medium Column

This part is the central part of the spine for its stability and includes the posterior half of the vertebral body and the intervertebral disc.Behind the vertebral body there is a ligament called the posterior longitudinal ligament, part of the medial column. The middle pillar is a sensitive part, and if the vertebrae are broken in this part, the chances of nerve damage and spinal instability are very high.

Rear column

All parts of the vertebrae in the dorsal part make up the posterior column, including the pedicle, plate, lateral joints and vertebral spines.

The most common classification of spinal fractures

The different types of spinal fractures are classified into different categories. The most common types of classification include compression, tear, flexion-distraction, and fracture-dislocation.

Compression Fracture

Compression fractures are more common in patients with osteoporosis or in patients whose bones have been weakened by other conditions (such as bone cancer). In this case, the bones are weak and cannot withstand the pressure, and even slight pressure can cause cracks and fractures in them. Compression fractures are also divided into wedge fractures, crush fractures, and rupture fractures.

Fracture fracture

Because of the importance of fracture fractures, this type of fracture can be considered a separate branch from compression fractures. This type of fracture occurs when a strong blow crushes the vertebrae. As a result of this fragmentation, pieces of bone are scattered throughout the body and can damage the spinal cord.

Flexion-Distraction

This type of fracture commonly occurs in road traffic accidents and is also known as “seat belt damage”. When the car falls, the upper body is pushed forward, but the lower body, which is fastened with a seat belt, remains in place. Under these conditions, a gap occurs between the vertebrae, and distraction of the fracture occurs.

Fracture-dislocation

If the vertebra is significantly displaced from its place with any fracture, it is called a fracture-dislocation. A fracture-dislocation causes a vertebra to move forward or backward, known as spondylolisthesis. This type of fracture causes spinal instability.

Transverse process fracture

The transverse processes of the vertebra project in three directions behind the vertebra, to the right and to the left. These processes are the connections of the ligaments and muscles; in accidents, when a strong force is applied to the body, the muscles contract and prepare for impact. These conditions can cause the spine to become uneven, resulting in a transverse process fracture (TPF).

Other types of vertebral fractures

Stable and unstable fractures

Among doctors, another type of classification of spinal fractures is widespread, according to which fractures are divided into two types: permanent and unstable.

For permanent fractures, the fracture does not deform the spine and does not cause nerve problems. Although as painful as the unstable type, this type of spinal fracture can still support and distribute body weight well, but in unstable fractures, support and weight distribution is difficult for the spine. Unstable fractures are more likely to progress and become damaged. They can also deform the spine.

Large and small fractures

A minor fracture is a fracture of a part of the dorsal elements of the vertebrae, that is, parts that have little effect on the stability of the spine.

Major fracture means a fracture of major parts of the vertebrae, such as a pedicle or plate. This type of fracture is necessary because the vertebral body carries most of the body’s weight, and if they are broken, they are not in the correct position and cause spinal instability.

Most critical causes of vertebral fractures

Fractures of the chest and lumbar spine can be the result of a car accident (45%), falls from a great height (20%), sports injuries (15%), violence (15%) and other factors (5%). In many of these cases, patients suffer serious spinal injuries.

Sometimes vertebral fractures occur due to bone weakness. Osteoporosis, tumors, and certain comorbidities cause bone weakness. These people can break their spines due to minor injury or even a fall from a short distance.

Symptoms of spinal fracture

Most vertebral fractures, regardless of where they are located, are associated with mild to severe pain that increases with each movement, depending on where the spinal fracture is located.In more severe cases, the fracture can cause neurological symptoms such as numbness, tingling, muscle cramps, weakness, bowel and bladder problems, or even paralysis.

For impression fractures, movement increases pain, which is relieved by rest. Sometimes fracture pain spreads to the legs and abdomen. In cases where the fracture is not treated, the person sees that its growth is shortened.

Flexion distraction is associated with severe back pain that worsens with movement. If the severity of the injury is high, it can lead to brain damage and loss of consciousness.

Methods for diagnosing spinal fractures

Patients who have suffered a spinal fracture as a result of a severe accident require immediate treatment. On a first assessment, it can be difficult to assess the extent of their damage.

At the scene of the accident, rescuers first examine the patient’s vital signs, including alertness, breathing ability, and heart rate. Once vital signs have been established, they assess the bleeding and damage that led to the limb deformity.The victim’s spine is held in place with medical cervical braces and lumbar braces before being transported to the hospital.

Clinical examinations in the hospital begin with a physical examination. The patient’s nervous status will be checked, and his reflex and ability to move will be assessed. If your doctor suspects a spinal fracture, they will do a more detailed examination.

Fractures of the cervical, thoracic or lumbar spine can be detected by radiography. If necessary, computed tomography will be used – an effective way to visualize any changes in the bone structure. An MRI can also be done to evaluate the surrounding soft tissue, ligaments, intervertebral discs, or to look for any damage to the spinal cord.

Methods for the treatment of spinal fractures

Treatment of a spinal fracture depends on the location and type of the fracture, as well as on the amount of pressure exerted on the nervous system. Fracture treatment begins with managing and stabilizing pain to prevent further injury.Depending on the type of fracture and its stability, a spinal brace may be required to stabilize the spine and restrict its movement.

Small fractures can be treated with spinal braces, but more complex fractures where there is potential for spinal cord injury requires surgery.

Fusion surgery is required for unstable fractures. In this type of surgery, by connecting the vertebrae and fixing them with implants, they are prevented from moving and the spine is healed.

Impression fractures often heal without surgery to repair the fracture. Nonsurgical treatments include rest, pain relievers, and spinal braces to restrict movement, but if pain persists after nonsurgical treatment, minimally invasive surgery options may be considered. Vertebroplasty and kyphoplasty are minimally invasive surgeries performed to treat impression fractures caused by osteoporosis and spinal tumors.

Non-surgical treatment of flexion-distraction consists in immobilization of the spine using spinal braces and plaster casts.These types of fractures often require surgery to relieve pressure and stabilize. Surgical procedures include vertebrectomy and fusion or transplantation.

A fracture of the transverse process can be treated without surgery with rest and gradual increase in motion. A spinal brace may need to be used, but the dislocation fracture requires surgery to fix it.

After the spinal fracture has healed, physical therapy and exercise such as walking, yoga, tai chi and leisurely dancing help the patient return to daily life.

Who is most at risk for spinal fractures?

• 80% of patients 18-25 years old
• Men are four times more likely to have a spinal cord fracture than women.
• People with osteoporosis
• Athletes, especially in the field of motorsport, football, horse jumping, gymnastics, rock climbing, bungee jumping and the like

How to prevent a spinal fracture?

While not all accidents are preventable, there are a number of precautions you can take to reduce your risk of spinal fractures.

Always wear your seat belt in your car because seat belts and airbags are designed to protect you in the event of an accident. They protect the head, neck and chest.

Use calcium and vitamin D in your diet to prevent the progression of osteoporosis.

If you have osteoporosis or weak bones for any other reason, your bones can break if you fall even from a short distance, so reduce the factors that make you fall. For example:

• Remove any rugs where you might slip.
• Make sure there are no obstacles in your way.
• Place a non-slip rubber mattress in the bathroom.
• The staircase must be well lit.
• Try to leave the stairs and everything else.
• Be sure to wear safety equipment when exercising.
• Prevent the progression of osteoporosis with proper exercise.

Output

Fractures of the spine are different from fractures of the bones of the arms or legs. A fracture or dislocation of a vertebra can lead to fracture of the bones of the vertebra and damage to the spinal nerves. Most spinal fractures occur as a result of car accidents, falls, gunfights, or exercise. Injuries can range from relatively mild ligament and muscle strain to spinal cord injuries. Depending on the severity of the injury, a spinal fracture may cause pain, difficulty walking, or inability to move your arms or legs.Many fractures heal with careful treatment. However, for severe fractures, surgery may be required to restore the position of the bones, and this treatment will vary depending on the type of fracture.

90,000 Injury to the thoracic and lumbar spine

Statistics

The frequency of spinal cord injury is about 100 people per 1 million of the population per year. Of these, 70% are accounted for by injuries of the thoracolumbar spine.About 3% of patients remain deeply disabled.

Description

The thoracic region consists of 12 vertebrae. From the vertebral bodies, on each side, there are ribs that are connected in front with the sternum. This part of the spinal column is less mobile than the cervical and lumbar spine. Below is the lumbar region, which consists of 5 vertebrae. It carries the most load. If you look at the spinal column from the side, you can see that in shape it resembles a spring, one bend of which smoothly turns into another. This shape is necessary for better balance and even distribution of the load. In the thoracolumbar region, between the 11th thoracic vertebra and the 2nd lumbar thoracic kyphosis becomes lumbar lordosis, and the vertical load axis passes through the bodies of this region of the vertebrae. Therefore, with spinal injuries, the greatest number of injuries occurs in this area. The upper thoracic and lower lumbar regions are much less affected. The exceptions are compression fractures of the vertebral bodies in osteoporosis, in which the thoracic spine suffers more.

Mechanisms and causes of injury

Fractures of the spine are high-energy trauma because it requires the application of great force to occur. The most common causes are road traffic injuries and falls from a height. Fractures of the spine almost always occur not due to a direct effect on the fracture site (with the exception of gunshot wounds), but due to an indirect effect on the spine as a whole. From the nature and direction of action of the force, injuries are due to a sharp compression of the spine along the axis (falling from a height to the legs or buttocks), flexion (hitting the passenger against the back of the front seat), extension (hitting a pedestrian from behind), stretching (getting into moving mechanisms) and twisting (motorcycle injury).It is also possible to shift the vertebrae and a combination of all these mechanisms.

Types of spinal injuries

Proceeding from the mechanism of trauma, this or that type of fracture occurs. The modern international classification, proposed in 1994 by Mugerl, divided all injuries into three groups: A – injuries of the vertebral bodies as a result of compression along the axis of the spine; B – damage resulting from flexion – extension; C – injuries of the two previous groups in combination with a shift of the vertebrae and rotation.Depending on the volume and characteristics of the injury, these groups of injuries are divided into three more types. This classification gives the doctor an idea of ​​the stability or instability of the damage and determines the characteristics of the treatment in each case.

Diagnostics

First of all, the patient should be carefully examined for the presence of neurological symptoms and the area of ​​the alleged injury. Due to the fact that the external picture does not always correspond to the volume of damage, at the first stage of the examination, an overview radiography is performed.In severe injuries (road, fall from a height, train injury), an X-ray examination of the entire spine is necessary, since due to the severity of the condition, the patient cannot always clearly indicate the source of the pain. At the second stage, when a damaged vertebra (or several) is detected, multispiral computed tomography is performed, thanks to which it is possible to draw a conclusion about the nature of bone damage, displacement by a fragment and the stability of the damage. Magnetic resonance imaging can provide additional insight into damage to the soft tissue structures of the spine – ligaments, intervertebral discs, spinal cord.But if there is no MRI scanner in the hospital, then it is not advisable to transport a patient with a spinal fracture to another institution for an MRI scan. Shifting and transportation are very dangerous in case of unstable fractures and can lead to irreversible neurological damage due to mixing of fragments and compression of nerve tissue.

Treatment

Stable uncomplicated compression fractures of the vertebral bodies with a decrease in height in the anterior regions of up to 50% are treated conservatively.It is recommended to wear an orthopedic corset for 4-6 months. In some cases, if the patient wants a quick recovery without prolonged external fixation, options for surgical treatment using minimally invasive technologies can be considered. All complicated and unstable fractures are subject to surgical treatment. Depending on the nature of the injury and the type of fracture, various options for surgical interventions are used. The general principle of surgical treatment is to eliminate compression of the spinal cord and nerve roots, restore the correct axis of the spine, create the necessary conditions for fracture consolidation and securely fix the damaged segment of the spine.We use the most modern fixators, we strive to avoid large incisions and traumatic operations as much as possible, we widely use microsurgical techniques and endoscopy.

Clinical cases

Minimally invasive transpedicular fixation of a compression-comminuted fracture of the L1 vertebra with puncture restoration of the vertebral body with bioactive osteoinductive material.

Anterior spondylodesis with autologous bone with fixation with a plate from a transthoracic access for multiple fracture of the eighth thoracic vertebra.

Anterior lumbar spinal fusion with the installation of a prosthesis of the vertebral bodies and fixation with a plate for complicated explosive fractures of the bodies of the second and third lumbar vertebrae.

90,000 Consequences of spinal injuries

Reasons

A spinal injury means any traumatic injury to the structures of the spinal column: bones, ligaments, spinal cord. This is a very common problem today, since there are more than enough opportunities for such injuries.This includes road traffic accidents, industrial injuries, and domestic and notorious diving injuries. In about 25% of cases, these injuries are combined with damage to the spinal cord and are called vertebral-spinal. Such injuries have very serious health consequences and very often lead to disability.

Depending on the level of damage, injuries can be in the lumbar, thoracic and cervical spine. And the spine fracture itself: compression, comminuted, mixed and with dislocations.Taking into account the nature of the damage, they are distinguished in more detail: bruises of the spinal column, distortions (ruptures of ligaments and joint capsules), fractures of the vertebrae, their arcs and processes, dislocations and fracture-dislocations, displacement of the vertebrae.

Symptoms

The main manifestation of trauma will be pain, either localized or spreading over a large area. Even if the spinal cord is not injured, the injury will cause swelling of nearby tissues, which will be accompanied by neurological symptoms.The dysfunction of the spinal cord will manifest itself depending on which department the injury occurred in. The most life-threatening symptoms will be with an injury of the cervical spine, up to respiratory failure, cardiac activity and complete paralysis of the body. The milder lesions will experience general muscle weakness and numbness. Lesions of the thoracic region are manifested by impaired movement and sensitivity of the arms and chest, and sometimes legs. Injury to the lumbar spine will be characterized by paralysis or weakness of the legs, loss of sensitivity in them.Also, a common manifestation in cases of lumbar trauma is a dysfunction of the pelvic organs.

In general, the severity of the manifestations of spinal trauma and the duration of its consequences will depend on a large number of very different factors: the extent and location of its localization, spinal cord injury, age, general condition of the victim and, of course, the quality of medical care provided.

Treatment

In the very first, acute period (from weeks to several months) after the injury, clinical manifestations are likely to be extremely unpleasant.But after this period, further actions aimed at rehabilitation become of great importance. The fact is that the neurological function, which has been impaired for a long time, will recover worse and worse over time. Therefore, immediately after the first period spent in the hospital, after a spinal injury, the question of its further recovery inevitably arises. Rehabilitation measures for any spinal injury should be started as soon as possible and carried out as actively as possible. Only in this case there is a chance to maximize the return of the impaired or lost functions.As practice shows, in the long term, recovery even after severe injuries is possible if you do it persistently and constantly. The road to full recovery can be long, challenging, and demanding in terms of personal strength. However, it is worth remembering that the first 1. 5 years remain the most favorable for recovery.

When working with a spinal injury, it is necessary to use the most famous and effective methods of returning it to a healthy state to the maximum.Today, with the help of modern knowledge in the field of rehabilitation and using the best methods, it has become possible to significantly restore the lost functions. Compulsory rehabilitation measures will include systemic exercise therapy, therapeutic massages, acupuncture, physiotherapy.

Treatment by methods of Chinese medicine

In neurotrauma, restoration of the disturbed innervation will be the decisive moment. Physical activity helps to restore nerve connections, however, they have a limitation in their capabilities, especially in the conditions of their interrupted work.In addition, the dynamics of improvement is usually not very fast. And here acupuncture and other methods of oriental medicine will be the most effective method. For a reason, acupuncture is actively used in rehabilitation centers around the world when it comes to recovering from injuries. Reflexology is generally a powerful activating method, and today, in the treatment of injuries, it remains one of the most optimal and effective methods. Its influence is directed towards the restoration of blood circulation and the conduction of nerve impulses in damaged tissues, as well as on the strengthening and inclusion of inactive connections.In the most severe cases, acupuncture helps relieve pain, prevent atrophic processes and contractures, and strengthen weakened muscles.

The best effect is achieved, of course, with a combination of various methods and mandatory monitoring of the effectiveness of the therapy. However, the eastern methods, due to their merits, the absence of side effects and contraindications, and also in the absence of the need for the patient to overcome himself, are able to provide the most invaluable assistance in this entire difficult recovery process.

90,000 Treatment of a spinal fracture in a dog. What to do if your dog has a spinal fracture

Contents

1. Signs
2. Treatment

Spinal column injuries are not uncommon in veterinarian practice. The most common causes of spinal fractures in dogs are car injuries, blows to the area, and falls from a height. Unlike humans, animals, when injured, cannot control their behavior and inflict even more harm on themselves.Knowing this, the owner of the injured animal must immediately ensure rest, restrict movement and transport the animal on a hard surface to the veterinary hospital.

Signs

Clear signs of spinal cord injury are soreness in the back, gait disturbance, lethargy and paralysis of varying degrees, with impaired urination and defecation. To make an accurate diagnosis, the doctor excludes concomitant injuries, assesses the neurological status and resorts to additional diagnostic methods.The simplest and most accessible method is X-ray: on it we can see fractures of the vertebrae and their structures, as well as dislocations of the vertebral joints. The second necessary research method is magnetic resonance imaging, which will reveal structural abnormalities in the spinal cord and hematomas in the spinal canal.

Treatment

Depending on the severity of the situation, the veterinarian recommends conservative or surgical treatment. Conservative treatment can be recommended for animals with minor damage to the spinal column, which is not accompanied by impaired motor functions.Such treatment is reduced to a restriction in mobility and the appointment of anti-inflammatory therapy. When the spinal cord is compressed as a result of trauma, surgery is needed to decompress the spinal cord and stabilize the spinal column.

Almost always, after the operation, the animal needs a long period of rehabilitation with the use of physiotherapy (swimming, water treadmills, etc.). All these procedures are carried out under the strict supervision of veterinarians.

An integrated approach in the diagnosis and treatment of animals with spinal column injuries with timely treatment in the clinic allows you to achieve the maximum effect during treatment and significantly improve the prognosis for the life and health of the pet.

The article was prepared by the doctors of the surgical department “MEDVET”
Traumatologist – about typical severe summer cases | HEALTH: Medicine | HEALTH

From spring to autumn, traumatologists have a hot time. The number of patients doubles – up to 200 people a day. In the hospital there are not only children who are on vacation, but also summer residents and motorcyclists.

Is it possible to get away with scratches when falling from the seventh floor, and why cut off fingers cannot always be sewn back, AiF-Tyumen correspondent found out from the traumatologist of the Regional Clinical Hospital No. 2 Maxim Rabchenyuk.

Weak muscles

Lilac Babaeva, “AiF-Tyumen”: What is the most common treatment in the warm season?

Maxim Rabchenyuk: Bruises, sprains, fractures – just like at any other time of the year. But in the summer, the circumstances of the teaching of these injuries change. So, the trouble of recent years is falling from windows. This almost always ends in multiple fractures. Much depends not only on which floor a person fell from, but also where he will land.If on the asphalt, then falling even from a low height, you can get serious injuries. Sometimes trees, bushes soften the fall, in which case there is a chance to get off easily. In case of fractures, the possibility of recovery depends on the severity of the injury. If uncomplicated fractures of the bones of the arms and legs are diagnosed, then everything will be fine. In the case of spinal cord injury, it all depends on whether the spinal cord is damaged, and if so, how much.

In summer, children, and sometimes adults, more often get a compression fracture of the vertebrae – when jumping on a trampoline, jumping off fences, garages, roofs of country houses.The danger of such damage is that the patient may not immediately notice the problem. At the moment of injury, the pain is not so strong as to recall an ambulance, and after a while it may even go away. Here’s what should be alarming: holding your breath at the time of injury – after a jump, a person cannot inhale or exhale for several seconds. You can also ask the victim to bend over. And if the pain returns in the same place – faster to the emergency room.

In the summer, they often get a compression fracture of the vertebrae when jumping on a trampoline, jumping from roofs.Photo: pixabay.com

– Some experts say that children are now less mobile and therefore more likely to get injured. Allegedly, what 25 years ago ended in a bruise can lead to a fracture today, do you agree with that?

– It’s not just kids. The phenomenon is also typical for young people, adults, adhering to a passive lifestyle. Yes, a person who regularly receives physical activity can get off with a bruise when falling. The one who sits more than runs and jumps, in the same situation, is likely to get a complicated fracture and ligament rupture.Most of the injured children and adults are people who do not play any sports at all, lead a sedentary lifestyle, and neglect basic safety rules. We are not encouraging everyone to join the professional sections, but there should be physical activity. Now children and adults sit more, they have the main “route” – from school (work) to home, from TV and computer to the kitchen and back. The human body gets used to the conditions that are created for it, including the minimum of physical exertion.As a result – a weak muscle corset and ligaments, the body is simply not trained to maintain balance and adequately respond to the same falls.

– How dangerous are your favorite summer activities: bikes, roller skates, skateboards?

– Bicycles are in the first place in terms of danger. Falling from them, children and adults are more likely to receive injuries to the shins, legs, and can break their arms if they fly over the fork during sudden braking. Rollers and skateboards are in second place. Falling from them you can “earn” sprains of the ankle joints, abrasions, bruises.Fractures can also be. In addition to the arms and legs, they break a bone in the elbow. It is very painful and takes a long time to heal – up to six months. We always remind patients to use protective equipment. Even the most inexpensive models can reduce the severity of injury.

Even the most inexpensive protective gear can reduce the severity of injury. Photo: From personal archive / Valentin Popov

Kills speed

– In the summer, adults also add work to you. And why do they get injured?

– Most often these are summer residents who are injured while working in the country with an ax or a saw.There are frequent injuries received from broken, scattered discs of grinders, circulars. The number of treatments for cut wounds in the legs and hands is increasing – all from the same construction power tools. In winter, there are usually five to seven household wounds a day, in summer – this figure reaches 35.

– Sometimes working with sawing power tools ends up with severed fingers and limbs. Can I sew them back on?

– If you completely cut it off, then it rarely turns out to be sewn back – only if the edges of the cut are even. The grinder leaves torn edges, and there is practically no chance that the cut will be “put back in place”. The level of damage also matters. For example, if you cut off the nail phalanx of a finger, then it will not work to sew it on due to the fact that there are too thin blood vessels, which cannot be connected even under the magnification of modern microscopes. It is important that the patient and the limb amputated as a result of the injury are quickly, within an hour, taken to the hospital. In this case, the body fragment must be transported correctly.You cannot throw a severed finger into an ice bag, as in the movies: the tissues will become soaked, and the fragment will be unsuitable for reimplantation. The amputated parts of the body must be put in a bag, sealed, and only then lowered into a container with ice.

You can’t throw a severed finger into an ice bag like in a movie. Photo: pixabay.com

But if the limb is not completely cut off, then there is a chance to save it. We recently had a similar case. The man almost completely cut his finger with a grinder, he kept on a piece of skin, in which the subcutaneous artery and vein survived.Thanks to this, the blood supply to the fragment was not disturbed, and the doctors were able to fully restore the function of the hand.

– Are motorcyclists frequent “clients” of traumatologists during the warm season? How are their injuries different from the consequences of car accidents?

– Motorcycle enthusiasts almost always have a higher severity of craniocerebral injuries, fractures of arms, legs, and pelvic bones. Much more often they have open fractures of the shin and hip, because in the event of an accident, the motorcycle is “put” on itself, and the shin is literally twisted.We had a case when a motorcyclist in an accident with a fuel tank crushed his scrotum so that he had to remove it. He is now on hormone replacement therapy for life. I have never seen such an injury in a car accident.

– Can you tell from your injuries what happened (accident, fall from a height, beaten)?

– Exactly, of course not, but this is not our task. But to assume the circumstances in which the person was injured – yes. It happens that the patient hides the fact of an accident.For example, one of them – with a fractured thigh on one leg and a lower leg on the other – claimed that he had fallen down the stairs at the dacha. But by the nature of the damage, it is clear that their cause, most likely, was an automobile injury. Falls from a height are characterized by fractures of the bones of the heels and spine. In an accident, chest injuries, craniocerebral injuries, fractures of arms and legs are more often diagnosed, and if they are on different limbs, then, most likely, the victim is a motorcyclist.

Miracle happens

– There is an opinion that most often drunk drivers get off with scratches in an accident, like drunk people in general?

– This is a myth.In our practice, we see the opposite: in a state of drug or alcohol intoxication, patients receive more serious injuries, which become the cause of death. The legend of “immortality” was probably invented by people who love to drink to justify themselves. In part, the spread of this myth is facilitated by modern advances in medicine. If earlier a person with fractures of the leg bones was forced to lie motionless for a long time, now, thanks to the methods of osteosynthesis, he can independently move on the third or fourth day after the operation.Six months later, when the bones are completely healed, the patient completely forgets about the unpleasant situation he was in. People are so accustomed to the fact that they can be helped even in the most difficult moments that they lose their sense of self-preservation. We have regular patients who believe that there is nothing wrong with a fracture, once a few days later they were back on their feet. Because of this, they do not take care of themselves.

The fact that drunk drivers get off with scratches in an accident is a myth. Photo: pixabay.com

– How long does it take to recover?

– It all depends on the trauma and the individual characteristics of the body of a particular person. If this is an isolated fracture of the spine, then under favorable conditions, the fusion of the vertebra usually occurs within six months. A leg fracture is four months, a hip fracture is six months, and when these injuries are combined, the recovery time increases. Rehabilitation will also take a lot of time, after the fusion of bone fragments, some have to re-learn to walk and develop joints.How quickly a patient recovers depends not only on the capabilities of modern medicine. If the patient tries himself, wants to live, then sometimes something happens that they say “a miracle”.

– Is it possible, after the first examination, by the severity of the injuries, to say whether a person will be able to return to his former life or will he be bedridden?

– Based on the results of the examination, yes, it can be assumed how the rehabilitation will take place. For example, the integrity of the spinal cord is assessed on x-rays for a spinal fracture.If the rupture is partial, it is hoped that the patient will avoid profound disability. With a complete anatomical rupture of the spinal cord, unfortunately, the prognosis is poor, the person will remain paralyzed. The chances of complete recovery are also low in the case of comminuted fractures of the cervical vertebrae with compression. By the way, most often such injuries are received by divers. When they hit the bottom of the reservoir, they break the vertebrae – the upper thoracic or cervical. And if the spinal cord is severely damaged, then a person can breathe and talk, but not move his arms and legs.It is sad that in 90% of cases, patients with such injuries are young people under 30, who have their whole life ahead of them.

Spinal cord integrity is assessed on x-rays for spinal fractures. Photo: pixabay.com

Advice to lovers of recreation by the reservoir: if it really happened, then remove the victim from the water as carefully as possible. There have been cases when the vertebrae broke, and the spinal cord remained intact or not completely damaged. But when the victim was clumsily turned, getting out of the water, pulled along the ground, bone fragments, like a knife, cut the spinal cord, and the person became disabled.If you really cannot do without diving, then before jumping into the water, conduct a reconnaissance of the bottom of the reservoir, even if you have been swimming there all your life. It happens that the bottom topography changes over the winter – the current brought a snag and caused a sandbank, something sank in late autumn. Believe me, the saying “not knowing the ford, do not poke your nose into the water” is not in vain.

About security

• Use tools correctly. Do not move the blade from the circular saw to the grinder. A finger cut off by a grinder cannot be sewn.
• Do not forget gloves (they should be non-slip) and safety glasses.
• Use a hand saw or hacksaw whenever possible – this is slower but safer.
• When working at heights, secure yourself with a rope, ask to hold the ladder, secure from the ground.
• Check the bottom before diving.

Candidate of Medical Sciences, Senior Resident of Traumatologist-Orthopedist of the Surgical Department No. 3, Traumatologist-Orthopedist of the First Qualification Category GBUZ TO “OKB No. 2”
Education: GOU VPO TSMA, diploma with honors IVS 0051544 from 19.06.2009, Doctor with a degree in General Medicine. Specialization: GOU VPO TSMA, residency from 2009 to 2011. specializing in Traumatology and Orthopedics. In 2011 he received a certificate in Traumatology and Orthopedics.

90,000 My son broke his spine in kindergarten, but no one was punished for this

A six-year-old boy Artyom broke his spine, jumping off a slide on the playground of the Khabarovsk kindergarten No. 78. The mother of the injured child, Natalya Shiryaeva, believes that Artyom was not followed by the teachers.She wrote a statement to the police, but the law enforcement officers did not initiate a criminal case. In the kindergarten, the correspondent of the portal “Gubernia” was told that an accident had occurred with the child and that the teachers had nothing to do with it.

Natalya Shiryaeva said that her son was injured in the spring of 2017.

“I found out that Artyom was in trouble on March 15 – the kindergarten workers told me about it by phone. When I ran into the garden, the child was lying in bed and complaining of back pain.In the emergency room, he was given a preliminary diagnosis – a closed compression fracture of the spine of the first degree (an injury sustained under the pressure of his own body weight). At the Piotrovich Regional Children’s Hospital, doctors confirmed the diagnosis, and Artem spent 21 days in the ward. Then I found out that my son was not followed by the teacher, who alone had to watch the whole group of children playing. On March 18, I wrote an application to the third police department against the workers of the kindergarten, ”says Natalya Shiryaeva.

The initiation of a criminal case was refused, but after Natalya turned to the prosecutor’s office, the materials of the police check were taken from the archive. In June, they were handed over to the Industrial District investigators. According to Natalia, nothing has changed since then.

“On April 16, they refused to initiate a criminal case, allegedly due to the lack of corpus delicti. Then I complained to the Prosecutor’s Office of the Industrial District, after which the consideration of the case was resumed, and on June 22 the materials were handed over to the investigators.It seems to me that the investigation is deliberately delayed so that all the deadlines are expired, because the materials are still in the Investigation Department of the Industrial District, “added the Khabarovsk woman.

In September, Artem went to first grade. Natalia claims that the boy still feels the consequences of the injury.

“He was forbidden to walk without a medical corset; he also cannot sit at a desk for a whole lesson. Artem attends physical education classes with restrictions. Even a backpack he hardly carries.The child is suffering, so I will strive to ensure that the kindergarten teachers and management are punished within the framework of a criminal case, ”said Natalya Shiryaeva.

The acting head of kindergarten No. 78 refused to give official comments on the March incident, although she confirmed that such an incident had actually taken place in kindergarten. She added that the employees were not to blame for this incident, and the slide, from which the child unsuccessfully jumped off, was installed according to all the rules.

Recall that on October 4, an accident occurred in another Khabarovsk kindergarten – No. 185: there a three-year-old girl broke her arm. The victim’s parents claim that the kindergarten management did not explain to them under what circumstances the child was injured.

Last Wednesday, October 11, in one of the hospitals in Komsomolsk-on-Amur, a child died, who was brought from a kindergarten by ambulance. This case became a pretext for a criminal case.

Spine corset

Spine corset
90,000 Cat tail fracture, symptoms and treatment

What happens when a cat breaks its tail?

A cat’s tail is an extension of the spine made up of the bones of the vertebrae, blood vessels, nerves, and muscles.Although the spinal cord stops at the base of the tail, numerous nerves radiate from it and continue to move.

A cat’s tail is usually active and agile, helping to maintain balance. He can also tell you the mood of the pet, for example, when he is annoyed, he angrily shakes his tail back or forward. If the tail is directed downward, this means that something is not right. Your cat may have a broken bone, dislocated vertebrae, or a sprain. In all cases, the nerves and blood vessels in this area are often damaged, so you should not postpone your visit to the veterinary clinic.

How do you know if your cat has a broken tail?

The most common sign of a fracture is a drooping tail. But there may be additional signs, as some of the nerves at the base of the tail also control the hind legs, bladder, and intestines:

● The tail hangs, drags or does not rise high

● There is an unnatural bend, wound, blood, swelling

● Pain at the fracture site

● The cat may behave restlessly and aggressively, or vice versa, seek a secluded place

● Involuntary flow of urine

● Dilated flaccid anal sphincter with or without diarrhea or fecal incontinence

Any of these symptoms are grounds for a veterinarian examination and examination.Some additional findings a doctor may notice include:

● A distended bladder that is relatively easy to express by hand (in other words, the bladder is very full but can be emptied by gently squeezing)

● Bloody urine (if the tail injury is recent)

● Painful base of the tail

● Loss of sensitivity in the tail.

What to do if a cat has a broken tail?

The first thing you need to do is help your cat to stay calm.She may be scared and in pain, so it is your responsibility to help her calm down. Make sure your pet is resting in a comfortable and cozy place, such as on a bed, in a box or cat carrier. Speak in a low voice and pat your pet on the head to make him feel comfortable. Make sure there are no other stressors around the cat, such as loud noises, other pets or people, etc.

Now that your pet is a little calmer, you can visually observe the tail.Is it sluggish, swollen, or bleeding? Observe any abnormal behavior in your cat. Is she crying or hiding? You should take all of this into consideration when talking to your veterinarian about what happened, as well as about the symptoms your cat is having. Do not touch the tail as this may cause more pain or damage to the animal. If you need to touch the damaged area, for example, to stop bleeding, do so very carefully.

It is best to take your pet to the veterinarian as soon as possible so that the injury is correctly diagnosed with an X-ray and treatment can begin.

Cat tail fracture treatment

Each injury is individual, therefore it is the veterinarian who must diagnose the fracture and find the appropriate therapy tactics. Let’s take a look at some of the treatments for a cat tail fracture:

● Minor tail fractures

In most cats, a broken tail will heal naturally, but over time. A mild degree means that the injury did not affect the nerves or blood vessels.In these cases, your veterinarian will simply make sure the fracture heals properly and prescribe pain relievers for your cat to relieve the pain.

Important: under no circumstances give your pet pain relievers for humans. Most are toxic to the cat’s body and can lead to severe liver and kidney dysfunction and even death.

● Serious tail fractures

In severe tail injuries, the vertebra is broken, the nervous system or blood vessels are damaged.In these cases, when self-healing is not possible, your veterinarian may recommend tail docking. Fortunately, most cats recover very well from this procedure and adapt quickly. The pet will start jumping and playing as before in no time.

How long does it take for a broken cat’s tail to heal?

A broken tail, especially the nerves, takes time to heal. Full recovery can take up to six months.

If you think there is something wrong with your cat’s tail, it is important to see your veterinarian. Only a specialist can determine how extensive the injury is through examination and X-ray. Your veterinarian may also prescribe pain relievers and other medications your pet may need to help relieve discomfort as the injury heals. For most cats, care and rest is all it takes to use the tail again.

The most important thing to do if your cat is injured is to see your veterinarian as soon as possible.The sooner you see a doctor, the easier it will be for your pet to recover from an accident.