Treating osteoporotic fractures of the spine

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Several options, from pills to procedures, can help ease pain and shore up bone.

More than 1.5 million osteoporosis-related fractures occur each year in the United States, and nearly half of them are in the vertebrae, the bones of the spinal column. Vertebral fractures are twice as common as hip fractures; about 25% of postmenopausal women have had at least one. Unlike hip fractures, which almost always result from a fall, vertebral fractures usually involve little or no trauma. Vertebrae weakened by osteoporosis cannot withstand normal strain and pressure, so they may succumb to simple movement — bending over, turning quickly, or lifting a window sash.

About two-thirds of vertebral fractures have no symptoms and may go undiagnosed until they’re found on an x-ray taken for some other reason. A single fracture may seem of little consequence, but having had one has long-term implications, including a higher risk of new fractures. In a study published in 2007 in The Journal of the American Medical Association, researchers for the Study of Osteoporotic Fractures found that women with a history of vertebral fracture had a fourfold greater risk of experiencing a new one during the 15-year follow-up. They also had a higher risk for other broken bones, especially hip fractures.

The cumulative effect of multiple fractures can be devastating. Chronic pain, disability, and difficulty engaging in normal activities of daily life can lead to isolation, problems with relationships, and emotional difficulties — including depression, which develops in 40% of people with vertebral fractures. Vertebral fractures also raise the risk of premature death, though not to the degree that hip fractures do.

As the population ages, the rate of osteoporotic fractures in general is expected to rise. Fortunately, we have more ways to manage these fractures than we had even 10 years ago, including procedures that relieve pain, shore up damaged vertebrae, and reduce disability.

Consequences of vertebral fractures

A vertebra isn’t broken in the usual sense of the word. It doesn’t snap like a twig, or like a broken leg or arm. Instead, it collapses, the way a paper cup is crushed when you step on it. The common term for this kind of break is compression fracture.

The resulting pain may be sharp or dull, and it may be felt at the site of the fracture or farther away in the sides or the abdomen. In many cases, there’s little or no pain, and the chief sign is gradual loss of height or stooped posture. The amount of height loss and deformity depends on the number, location, and severity of the fractures.

Most people with vertebral fractures have one or two, commonly in the thoracic (mid-back) and sometimes in the lumbar (low back) region. One or two fractures are likely to produce a slight loss of height, but multiple fractures can contribute to a rounding of the back known as dorsal kyphosis, or dowager’s hump. Caused by a number of factors, including degenerative changes in joints, disks, and bones, kyphosis can profoundly affect appearance, mobility, and health. The spine becomes progressively more misaligned. The upper body is pitched forward and rounded. The space between the ribs and pelvis closes; the chest wall is cramped; and the abdominal organs get scrunched, causing the abdomen to bulge forward. In very severe cases, breathing may be difficult, and digestion impaired.

Cumulative compression fractures can cause almost as much physical and functional disability as hip fractures. Pain can become chronic as back muscles work harder to accommodate changes in the spine. A cane or walker may be needed, and riding in a car for more than a few minutes may become unbearable.

What to do about vertebral fractures

An x-ray of the spine can confirm the diagnosis. Vertebral compression fractures in postmenopausal women are usually caused by osteoporosis, but occasionally they result from trauma, infection, or a cancerous tumor.

Treatment for painful fractures starts with over-the-counter analgesics such as acetaminophen (Tylenol), aspirin, or ibuprofen (Advil or Motrin). Severe pain may require short-term bed rest and stronger drugs, starting with low doses of opiates, such as oxycodone (OxyContin), often combined with acetaminophen. Prolonged bed rest should be avoided, as it can contribute to bone loss and other health problems. Ice or heat packs applied to the affected area of the spine may also help.

A back brace is usually recommended to help manage pain and stabilize the spine as it heals. The brace is designed to hold the spine straighter than usual, relieving pressure on the damaged vertebrae and reducing the chance of further collapse. Healing can take up to three months. The brace shouldn’t be used longer than that because it can weaken trunk muscles. Patients are usually encouraged to get gentle exercise, such as swimming or walking, as soon as they can tolerate movement. Eventually, they should add trunk muscle strengthening to their routine.

Patients should be evaluated for osteoporosis with bone mineral density testing, and osteoporosis should be treated with standard osteoporosis drugs, such as the bisphosphonates alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva). Bisphosphonates can help with acute pain, but their main benefit is improved bone mineral density. Long-term, they can reduce the rate of new vertebral fractures by as much as 50%. Injectable bisphosphonates — zoledronic acid (Reclast, Zometa) and injectable Boniva — are an alternative for women who can’t take the oral form. Another bone drug, calcitonin (Miacalcin, Fortical), is less effective in improving bone mineral density but can provide some pain relief, although it’s not a substitute for analgesics. The bone-building drug teriparatide (Forteo), given by injection, increases bone mineral density and lowers vertebral fracture risk.

Procedures for treating vertebral fractures

Two minimally invasive procedures — vertebroplasty and kyphoplasty — involve the injection of a medical cement to stabilize compressed vertebrae. Introduced in the United States in the 1990s, they’ve become increasingly available for the treatment of fracture pain that doesn’t respond to more conservative therapy. According to Dr. John Pan, a radiologist at Boston’s Brigham and Women’s Hospital, bracing and analgesics are usually tried first “to see if the fracture heals on its own. If it doesn’t and the person continues to have pain — usually after four to six weeks — that’s when the procedure is considered.”

There are very few controlled studies comparing the long-term effectiveness and safety of vertebroplasty and kyphoplasty — with each other or with conservative treatment. It’s not clear whether either procedure improves spine stability or prevents fractures in the long run. But the main reason for these procedures is pain, and as many as 85% to 90% of people who undergo them experience immediate relief. A review of 21 studies involving 1,309 patients, published in 2007 in the journal Pain Physician, found that both techniques reduced pain by more than 50%.

No one knows exactly how these procedures do that. One theory is that the pain is largely an inflammatory response to the uneven distribution of mechanical forces caused by bone fragmentation. The cement is thought to help by restabilizing the vertebra, which reduces inflammation and thus pain. It’s also possible that the cement destroys pain-conducting nerve endings in the vertebra.

Before either procedure, MRI is usually performed to determine if the patient is likely to benefit. A good candidate is one whose MRI shows the presence of bone edema, or fluid, which is associated with recent fracture. If bone edema is absent, that implies the fracture has healed and is not what’s causing the pain. An MRI can also help ascertain whether a disk, the spinal cord, or other soft tissue is involved.

Both kyphoplasty and vertebroplasty are performed percutaneously (that is, through the skin), often as day surgery and under conscious sedation. If the fractures are numerous or severe, or the patient is older and in poor health — or cannot tolerate lying on his or her stomach — general anesthesia may be used. Sometimes an overnight hospital stay is necessary. Here’s what’s involved:

Vertebroplasty. Guided by computed tomography (CT) or fluoroscopy (real-time x-rays), a specially trained radiologist, neurologist, or orthopedic surgeon inserts a hollow needle through a small incision in the skin into the compressed portion of the vertebra. When the needle is in place, she or he injects a surgical cement (methyl methacrylate), which has the consistency of toothpaste. It’s mixed with an agent that allows the physician to see its flow into the vertebra. The cement hardens within about 15 minutes. The patient is monitored for two to three hours in the recovery room before going home.

Kyphoplasty. In this procedure, which is also image-guided and performed through tiny incisions in the back, inflatable balloons are inserted through tubes in both sides of the fractured vertebra (see illustration). The balloons are inflated, creating a cavity and restoring vertebral height. They are then deflated and withdrawn and the cavity is filled with cement. The procedure takes 30 to 60 minutes for each fracture and sometimes involves an overnight hospital stay.

What are the risks?

In well-trained and experienced hands, vertebroplasty and kyphoplasty are generally quite safe. But anesthesia always creates risks, nerves can be damaged during needle placement, and any procedure that involves cutting into the skin raises the possibility of bleeding and infection.

Cement leaks can be a concern, but with real-time monitoring using CT or fluoroscopy, the physician can spot them early and stop the injection. The main worry is that cement might leak into places where it could cause serious problems. In the spinal canal, for example, it can press on the spinal cord, or if it gets into the bloodstream, it can cause clots that travel to the heart and lungs. But these complications are extremely rare in the treatment of osteoporosis-related vertebral fractures. (Compression fractures resulting from tumors, infection, or trauma can be trickier and have a somewhat higher complication rate.)

Selecting the right patients helps avoid complications. For example, someone with a compression fracture greater than 70% of the height of the vertebral body isn’t a good candidate for either procedure, says Dr. Pan, because there’s too little room for the needle and cement, and leaking becomes more likely. Another red flag is a compression fracture on the spinal-canal side of the vertebra, where a cement leak could impinge on the spinal cord.

The long-term effects of cement in a vertebra are unknown; researchers are investigating the possibility that it increases the risk of fractures in adjacent vertebrae, possibly through a change in mechanical forces.

Some physicians think patients should undergo vertebroplasty or kyphoplasty as a first choice, instead of waiting four to six weeks to judge the effect of pain medications, bracing, and bed rest. But most believe that until we know more about the risks, benefits, and long-term effects of these procedures, trying conservative measures first seems prudent. Finally, if you are considering one of these techniques, be sure that the hospital has extensive experience with it — and top-flight imaging equipment.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content.
Please note the date of last review or update on all articles. No content on this site, regardless of date,
should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Vertebral Compression Fractures – Symptoms, Complications, Diagnosis and Treatments

Vertebral compression fractures (VCFs) occur when the bony block or vertebral body in the spine collapses, which can lead to severe pain, deformity and loss of height. These fractures more commonly occur in the thoracic spine (the middle portion of the spine), especially in the lower part.

Causes

In people with severe osteoporosis (weak, brittle bones), a VCF may be caused by simple daily activities, such as stepping out of the shower, sneezing forcefully or lifting a light object. In people with moderate osteoporosis, it usually takes increased force or trauma, such as falling down or attempting to lift a heavy object to cause a VCF. VCFs are the most common fracture in patients with osteoporosis, affecting about 750,000 people annually. VCFs affect an estimated 25% of all postmenopausal women in the U.S. The occurrence of this condition steadily increases as people age, with an estimated 40% of women age 80 and older affected. Although far more common in women, VCFs are also a major health concern for older men.

People who have had one osteoporotic VCF are at five times the risk of sustaining a second VCF. Occasionally, a VCF can be present with either minor symptoms or no symptoms, but the risk still exists for additional VCFs to occur.

People with healthy spines most commonly suffer a VCF through severe trauma, such as a car accident, sports injury or a hard fall.

Metastatic tumors should be considered as the cause in patients younger than 55 with no history of trauma or only minimal trauma. The bones of the spine are a common place for many types of cancers to spread. The cancer may cause destruction of part of the vertebra, weakening the bone until it collapses.

Symptoms

The main clinical symptoms of VCFs may include any of the following, alone or in combination:

• Sudden onset of back pain
• An increase of pain intensity while standing or walking
• A decrease in pain intensity while lying on the back
• Limited spinal mobility
• Eventual height loss
• Eventual deformity and disability

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When & How to Seek Medical Care

You should see a doctor to evaluate back pain if:

• You are older than 65 years old or younger than 12 years old
• Your pain is the same at rest as it is while active
• You have unintentional weight loss
• You have or have had cancer

You may first make an appointment with your primary care physician, or you can find a neurosurgeon using the Find a Board-certified Neurosurgeon tool on the AANS website.

Seek immediate medical attention at an emergency department if you have any of the following symptoms in addition to back pain:

• Loss of control of your bowels and bladder
• Severe pain, numbness, or weakness
• High fever

Testing & Diagnosis

While a diagnosis can usually be made through history and a physical examination, plain x-rays, computed tomography (CT) or magnetic resonance imaging (MRI) can help in confirming diagnosis, predicting prognosis and determining the best treatment option for the patient.

• X-ray: An x-ray produces a picture of a part of the body and can show the structure of the vertebrae and the outline of the joints. It will also show bone alignment, disc degeneration and bony spurs which may irritate nerve roots.
• CT or CAT scan: A diagnostic image created after a computer reads x-rays; can show the shape and size of the spinal canal, its contents and the structures around it. This test may be performed in conjunction with a myelogram of the spine to provide additional information. A myelogram involves a spinal tap where dye is administered near the spinal cord. This diagnostic study is ideal for showing bone detail including narrowing.
• MRI: A diagnostic test that produces 3-D images of body structures using powerful magnets and computer technology; can show the spinal cord, nerve roots and surrounding areas, as well as enlargement, degeneration and tumors.
• Dual-energy x-ray absorptiometry (DXA or DEXA) or bone densitometry: This test is the established standard for measuring bone mineral density and can determine if osteoporosis exists. The scanner painlessly and rapidly directs x-ray energy from two different sources towards the bone being examined in an alternating fashion at a set frequency. A DEXA scan can detect small changes in bone mass and is also more flexible since it can be used to examine both the spine and the extremities. A scan of the spine, hip or the entire body requires less than four minutes.

Treatment

Non-Surgical Treatments

Pain secondary to acute vertebral fracture appears to be caused in part by vertebral instability (nonunion or slow-forming union) at the fracture site. VCF-related pain that is allowed to heal naturally can last as long as three months. However, the pain usually decreases significantly in a matter of days or weeks. Traditionally, people with severe pain from VCFs have been treated with reduction in activities other than those which involve caring for yourself, medications, bracing or invasive spinal surgery, often with limited effectiveness. Extended inactivity should be avoided.

Over-the-counter pain medications are often effective in relieving pain. Both acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly recommended. Muscle relaxants and medicines for nerve/bone pain are often prescribed. Opioids should only be used for very short periods of time (1-2 weeks) for acute pain.

Back bracing can provide external support to limit the motion of fractured vertebrae, similar to the support a cast provides on a leg fracture. The rigid style of back brace limits spine-related motion greatly, which may help reduce pain.

While immediate treatment is essential to helping the pain and risks of the fracture, prevention of subsequent fractures is very important. Your physician may prescribe bone-strengthening drugs known as bisphosphonates (i.e.: Actonel, Boniva and Fosamax) to help stabilize or restore bone loss.

When conservative treatment options have proven ineffective, two minimally invasive procedures, called vertebroplasty and kyphoplasty, may be considered as treatment options. Recent advances in spinal procedures have reduced the need for invasive surgery in many cases.

Surgery

Vertebroplasty for the treatment of VCFs was introduced in the U.S. in the early 1990s. The procedure is usually done on an outpatient basis, although some patients stay in the hospital overnight. Vertebroplasty takes from one to two hours to perform, depending on the number of vertebrae being treated. The procedure may be performed with a local anesthetic and intravenous (IV) sedation or general anesthesia. Using x-ray guidance, a small needle containing specially formulated acrylic bone cement is injected into the collapsed vertebra. The cement hardens within minutes, strengthening and stabilizing the fractured vertebra. Most experts believe that pain relief is achieved through mechanical support and stability provided by the bone cement. Kyphoplasty is a modification of this technique where a balloon is used to help guide the cement and to increase the height of the collapsed bone. The spaces created by the balloons are then filled with the cement.

Patients with the following criteria may be considered candidates for vertebroplasty or kyphoplasty:

• Osteoporotic VCFs in any area of the spine that have been present for more than two weeks, causing moderate to severe pain and unresponsive to conservative therapy
• Painful metastases and multiple myelomas
• Painful vertebral hemangiomas (benign, malformed vascular tumors composed of newly formed blood vessels)
• Vertebral osteonecrosis (a condition resulting from poor blood supply to an area of bone, which causes bone death)
• Reinforcement of a pathologically weak vertebral body before a surgical stabilization procedure

Patients with any of the following criteria should not undergo these procedures:

• A VCF that is completely healed or is responding effectively to conservative therapy
• A VCF that has been present for more than one year
• Greater than 80-90% collapse of the vertebral body
• Spinal curvature, such as scoliosis or kyphosis, that is due to causes other than osteoporosis
• Spinal stenosis or herniated discs with nerve or spinal cord compression and loss of neurological function not associated with a VCF
• Untreated coagulopathy (a disease or condition affecting the blood’s ability to coagulate)
• Osteomyelitis (an inflammation of the bone and bone marrow, usually caused by bacterial infection)
• Discitis (nonbacterial inflammation of an intervertebral disc or disc space)
• Significant compromise of the spinal canal caused by impeding bone fragment or tumor

Complication rates for vertebroplasty and kyphoplasty have been estimated at less than 2% for osteoporotic VCFs and up to 10% for malignant tumor-related VCFs. The benefits of surgery should always be weighed carefully against its risks. Although a large percentage of patients report significant pain relief after these procedures, there is no guarantee that surgery will help every individual.

Follow-up

Follow all instructions given to you by your doctor, and ask questions if you are not sure what to do.

• Take any medications as prescribed.
• Applying ice to your area of pain may help. After one week after your pain starts, either ice or heat may be applied. Apply the one that makes your injury feel better.
• Do not do painful or strenuous activities or lift heavy objects until your doctor has cleared you to do so.
• Attend all follow-up appointments to ensure you are recovering well.

Resources for More Information

Author Information

Patient Pages are authored by neurosurgical professionals, with the goal of providing useful information to the public.

Julie G. Pilitsis, MD, PhD, FAANS, is a professor of neurosurgery and of neuroscience at Albany Medical College and chair for the department of neuroscience and experimental therapeutics. To date, she has served as chair of the AANS/CNS Section on Pain as well as chair of the AANS/CNS Section for Women in Neurosurgery. Dr. Pilitsis maintains an NIH sponsored research program focused on device optimization for neuromodulation and has published over 120 journal articles, four books and numerous chapters. She serves as functional neurosurgery section editor for Operative Neurosurgery and is on the editorial board of Neuromodulation.

Disclaimer

The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information provided is an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon online tool.

Vertebroplasty & kyphoplasty treatment of spine compression fractures

Overview

Vertebroplasty and kyphoplasty are minimally invasive procedures used to treat vertebral compression fractures of the spine. These painful, wedge-shaped fractures can be caused by osteoporosis and injury. Left untreated, they can lead to a humped spine (kyphosis). By restoring the vertebra height with a balloon and injecting cement into the fractured bone, patients can recover faster and reduce the risk of future fractures.

What are vertebroplasty & kyphoplasty?

In vertebral compression fractures (VCF), the body collapses into itself (more in the front than the back) producing a “wedged” vertebra (Fig. 1). When several vertebrae become wedge-shaped, people can develop a humped spine, called kyphosis. People with bones weakened by osteoporosis (a depletion of calcium) or multiple myeloma (cancer of the bone marrow) are especially prone to compression fractures. Activities, such as lifting a heavy object, sneezing, or coughing may cause fractures. VCFs can lead to back pain, reduced physical activity, depression, loss of independence, decreased lung capacity, and difficulty sleeping.

Figure 1. Side views of a normal spine and a spine with a compression fracture. An osteoporotic compression fracture causes the front of the vertebral body to collapse in a wedge-shape (red lines).

Vertebroplasty and kyphoplasty are similar procedures. Both are performed through a hollow needle that is passed through the skin of your back into the fractured vertebra. In vertebroplasty, bone cement (called polymethylmethacrylate) is injected through the hollow needle into the fractured bone. In kyphoplasty, a balloon is first inserted and inflated to expand the compressed vertebra to its normal height before filling the space with bone cement. The procedures are repeated for each affected vertebra. The cement-strengthened vertebra allows you to stand straight, reduces your pain, and prevents further fractures.

Without treatment, the fractures will eventually heal, but in a collapsed position. The benefit of kyphoplasty is that your vertebra is returned to normal position before the bone hardens. Patients who’ve had kyphoplasty report significantly less pain after treatment [1].

Studies show that people who get one osteoporotic fracture are 5 times more likely to develop additional fractures. It is important that people seek treatment for osteoporosis early, before fractures occur.

Who is a candidate?

Vertebroplasty or kyphoplasty may be a treatment option if you have painful vertebral compression fractures from:

• Osteoporosis (a depletion of calcium in bones)
• Metastatic tumor (cancer spread from another area)
• Multiple myeloma (cancer of the bone marrow)
• Vertebral hemangioma (benign vascular tumor)

You may not be a candidate if you have:

• Non-painful stable compression fractures
• Bone infection (osteomyelitis)
• Bleeding disorders
• Allergy to medications used during the procedure
• Fracture fragment or tumor in the spinal canal

Vertebroplasty and kyphoplasty will not improve old and chronic fractures, nor will they reduce back pain associated with poor posture and stooping forward. Traditional treatment used to involve waiting 4 to 6 weeks to see if patients improved on their own, but now it’s believed that waiting allows the bone to harden, making vertebroplasty or kyphoplasty less effective. Many doctors are now suggesting vertebroplasty as soon as the first week after a fracture for some patients because the results are significantly better [2].

The surgical decision

The surgeon will perform a complete medical history and physical exam. Diagnostic studies (MRI, CT, bone scan) may be included in your evaluation to make a diagnosis of vertebral compression fracture. Your surgeon will also determine if your spine is “stable” or “unstable” and will discuss with you all treatment options.

Who performs the procedure?

Kyphoplasty can be performed by a neurosurgeon, orthopedic surgeon, or interventional neuroradiologist. Many spine surgeons have specialized training in minimally invasive spine surgery. Ask your surgeon about his or her training and success rate with these procedures.

What happens before surgery?

In the doctor’s office you will fill out paperwork and sign consent forms so that your surgeon knows your medical history (allergies, medicines/vitamins, bleeding history, anesthesia reactions, previous surgeries, etc.). Presurgical tests (e.g., blood test, electrocardiogram, chest X-ray) may need to be done several days before surgery. Consult your primary care physician about stopping certain medications and ensure you are cleared for surgery.

Continue taking the medications your surgeon recommends. Stop taking all non-steroidal anti-inflammatory medicines (ibuprofen, naproxen, etc.) and blood thinners (Coumadin, aspirin, Plavix, etc.) 7 days before surgery. Stop using nicotine and drinking alcohol 1 week before and 2 weeks after surgery to avoid bleeding and healing problems.

You may be asked to wash your skin with Hibiclens (CHG) or Dial soap before surgery. It kills bacteria and reduces surgical site infections. (Avoid getting CHG in eyes, ears, nose or genital areas.)

Don’t eat or drink after midnight before surgery (unless the hospital tells you otherwise). You may take permitted medicines with a small sip of water.

Patients are admitted to the hospital the morning of the procedure. To minimize pain and discomfort, you will be given either general anesthesia, which puts you to sleep, or conscious sedation. Under conscious sedation you are awake, but feel no pain and may have no memory of the procedure.

What happens during surgery?

There are five steps to the procedure, which generally takes 1 hour for each vertebra treated.

Step 1: prepare the patient
You will lie on the operative table and be given conscious sedation. Once sedated, you will be positioned on your stomach with your chest and sides supported by pillows. Depending on the section of the spine (cervical, thoracic, or lumbar) where the compressed vertebra is located, your back or neck will be cleansed and prepped.

Step 2: insert the needle
A local anesthetic is injected in the area where a small, half-inch skin incision will be made over the fractured bone. With the aid of a fluoroscope (a special X-ray), two large diameter needles are inserted into the vertebral body through the pedicles (Fig 2). The fluoroscopy monitor allows the surgeon to see exactly where the needles are positioned and how far they are inserted. The needles are advanced through the bone using either a twisting motion or a tapping mallet. The needles are angled to avoid the spinal cord. Depending on the vertebral level, a single needle may be used.

Figure 2. Using fluoroscopy, the hollow needle (trocar) is inserted through the skin to a point behind the pedicle. The needle is tapped through the pedicle into the collapsed vertebral body (viewed from above).

Step 3: restore vertebra height (kyphoplasty only)
If the vertebra is significantly wedge-shaped, the surgeon will insert inflatable balloons through the needles into the vertebra. To insert the balloon tamps, the surgeon first uses a drill to create a working channel. The surgeon carefully inflates the balloons, raising the vertebra back to its normal height (Fig. 3). The amount of height restored depends on the age of the fracture. The balloons are deflated and withdrawn, leaving a space in the middle of the vertebra. This procedure is called kyphoplasty because it reduces unwanted kyphosis, or forward curvature, before the bone is stabilized.

Figure 3. The balloon is inserted into the working channel inside the vertebra, then inflated to raise the vertebra to the appropriate height.

Step 4: inject bone cement
Bone cement is slowly injected under pressure, filling the deepest area first, then withdrawing the needle slightly to fill top areas (Fig 4). The pressure and amount of cement injected are closely monitored to avoid leakage into unwanted areas. While complete filling of the vertebral body is ideal, it is not always possible or necessary for pain relief.

Figure 4. The balloon is removed and bone cement is injected into the cavity. Fluoroscopic x-ray shows cement in upper vertebra (red arrow) and needle inserted in lower vertebra.

Step 5: closure
The needles are withdrawn promptly before the cement hardens. The small skin incision is closed with skin glue or steri-strips. You will not be moved from the operating table until the remaining cement in the mixing bowl hardens.

What happens after surgery?

You will return to the recovery area. Your blood pressure, heart rate, and respiration will be monitored, and your pain will be addressed. You’ll remain lying down for the first hour after the procedure. After 1 hour you may sit up. After 2 hours you may get up and walk. Most patients stay in the hospital overnight for observation and are released the next morning. Some patients can be released home the same day. Be sure to have someone at home to help you for the first 24 to 48 hours.

Follow the surgeon’s home care instructions for 2 weeks after surgery or until your follow-up appointment. In general, you can expect:

Restrictions

• Avoid bending or twisting your back.
• Don’t lift anything heavier than 5 pounds.
• No strenuous activity including yard work, housework, and sex.
• Don’t drive the first 2-3 days or while taking pain medicines or muscle relaxers. If your pain is well controlled, you can drive.
• Don’t drink alcohol. It thins the blood and increases the risk of bleeding. Also, don’t mix alcohol with pain medicines.

Activity

• Get up and walk 5-10 minutes every 3-4 hours. Gradually increase walking, as you are able. 

Incision Care

• Wash your hands thoroughly before and after cleaning your incision to prevent infection.
• You may shower the day after surgery.
• If you have a Band-aid over the incision, remove it one day after surgery.
• Gently wash the incision covered in Dermabond skin glue with soap and water every day. Don’t rub or pick at the glue. Pat dry.
• If there is drainage, cover the incision with a dry gauze dressing. If drainage soaks through two or more dressings in a day, call the office.
• Don’t soak the incision in a bath or pool.
• Don’t apply lotion/ointment on the incision.

Medications

• Take pain medicines as directed by your surgeon. Reduce the amount and frequency as your pain subsides. If you don’t need the pain medicine, don’t take it.
• Narcotics can cause constipation. Drink lots of water and eat high-fiber foods. Stool softeners and laxatives can help move the bowels. Colace, Senokot, Dulcolax and Miralax are over-the-counter options.

When to Call Your Doctor

• If your temperature exceeds 101.5 °F or if the incision begins to separate or show signs of infection, such as redness, swelling, pain, or drainage.
• If you experience difficulty walking or bowel or bladder problems.

What are the results?

The sooner a fracture is repaired, the better the results. Vertebroplasy relieves pain in 75-90% of patients; however, it does not correct the wedge deformity, which can lead to repeat fractures.

In a recent study of kyphoplasty, pain levels in patients dropped from an average of 8.6 before surgery (on a 10-point scale) to 2.1 three months after surgery [1]. Additionally, of 51 patients who either couldn’t move around on their own or required assistance to move, only 8 patients couldn’t move around without assistance after three months. This reduction in pain and increased ability to move significantly improved the patients’ quality of life. Other studies in cancer patients with multiple myeloma have shown similar results.

What are the risks?

No surgery is without risks. General complications of any surgery include bleeding, infection, blood clots, and reactions to anesthesia. Complications in the treatment of vertebral compression fractures is less than 2%, and 5 to 10% in the treatment of tumors. The following are specific risks that should be considered:

Bone cement leakage. There is a slight possibility that bone cement can leak along the outside of the needle into surrounding soft tissues. This can also happen when the needle is removed from the vertebra. Cement can leak into the veins surrounding the vertebra. The surgeon closely watches the fluoroscope and stops injecting cement if this begins to happen. Cement can leak into the neural foramen where the spinal nerve exits the spinal cord. This can cause nerve pain (radiculopathy) and may require further treatment.

Nerve damage. Any operation on the spine comes with the risk of damaging the spinal nerves or cord, which can cause numbness or paralysis.

Sources & links

If you have more questions, please contact Mayfield Brain & Spine at 800-325-7787 or 513-221-1100.

Sources

1. Ledlie JT, Renfro M: Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels. J Neurosurg 98(1 Suppl): 36-42, 2003
2. Wong W, Reiley MA, Garfin S: Vertebroplasty/Kyphoplasty. J Women’s Imaging 2(3):117-124, 2000

Links
Spine-health.com

fluoroscopy: an imaging device that uses x-rays to view structures in the body in real time, or “live.” Also called a C-arm.

hemangioma: a benign tumor that forms from blood vessels in the brain or spinal cord.

kyphoplasty: a minimally invasive procedure used to treat vertebral compression fractures by inflating a balloon to restore bone height then injecting bone cement into the vertebral body.

kyphosis: abnormal curve of the thoracic spine, also called hunchback.

osteoporosis: a depletion of calcium in the bones making them weak, brittle, and prone to fracture. Common in elderly women after menopause. Can be prevented early in life with calcium and regular exercise to stimulate bone metabolism.

pedicle: the thin, bony bridge that connects the vertebral body with the outer processes.

vertebral compression fracture (VCF): a break in the vertebral body of the spine causing it to collapse and produce a wedge-shaped deformity.

vertebroplasty: a minimally invasive procedure used to treat vertebral compression fractures by injecting bone cement into the vertebral body.

updated: 1.2021
reviewed by: Andrew Ringer, MD, Mayfield Clinic, Cincinnati, Ohio

Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. This information is not intended to replace the medical advice of your health care provider.

Repairing Cracked Vertebrae and Compression Fractures

20 Jul Repairing Cracked Vertebrae and Compression Fractures

If you have osteoporosis, it’s important to be gentle with your body. Osteoporosis makes bones brittle and fragile, increasing the possibility of compression fractures and cracked vertebrae. These cracked bones often heal on their own within three months. In some cases, however, the healing process takes a little longer and causes significant back pain. The good news is that there are several surgical procedures that can help relieve the pain.

Kyphoplasty, vertebroplasty and spinal fusion surgery are some options to consider. They work better than medications and back braces and provide long-term relief. They do carry risks, however, so be sure to discuss these procedures with your doctor. Read on to learn more about these pain relief options for bone issues. We also invite you to learn more about Dr. Nikesh Seth and other providers including Dr. Anne-Marie Cosijns, Dr. Lisa Sparks, Dr. Michael Givens, and our team of Nurse Practitioners.

Kyphoplasty

A small balloon is put into the damaged bone. The balloon is then inflated so that it slightly lifts up the spine. Once the spine is in the correct position, the doctor removes the balloon. The space left behind is filled with cement.

Vertebroplasty

Vertebroplasty also involves the use of cement. The doctor uses an X-ray to guide a needle into the painful area. The cement is then injected into the damaged vertebrae. You will then need to lie on your back until the cement hardens (an hour or so).

Spinal Fusion Surgery

Spinal fusion surgery is the most extensive of these three surgeries and is recommended only in serious cases. Your doctor will recommend more conservative approaches first. This surgery uses bone grafts from your pelvis to help speed along new bone growth. The bone grafts and broken bones are held in place using rods, plates, and screws until they eventually fuse together naturally.

Let Scottsdale Pain Management Expert Dr. Nikesh Seth Repair Cracked and Fractured Bones

Even if you have bones that are not completely broken, a crack or fracture in your back can still cause significant pain. Scottsdale pain management experts at Integrated Pain Consultants have many treatment options – many which are non-surgical – that can help you find relief. Don’t let pain control your life. Make pain-free living your goal by scheduling your appointment online today –  (480) 626-2552.

Spinal Compression Fractures | Cedars-Sinai

Compression fractures of the spine generally occur from too much pressure on the vertebral body. This usually results from a combination of bending forward and downward pressure on the spine.

A common cause of compression fractures is osteoporosis. This disease thins the bones, often to the point that they are too weak to bear normal pressure. The thinning bones can collapse during normal activity, leading to a spinal compression fracture.

Spinal compression fractures are the most common type of osteoporotic fractures. These vertebral fractures can permanently alter the shape and strength of the spine. The fractures usually heal on their own and the pain goes away. However, sometimes the pain can persist if the crushed bone fails to heal adequately.

In severe cases of osteoporosis, actions as simple as bending forward can be enough to cause a “crush fracture,” or spinal compression fracture. This type of vertebral fracture causes loss of height and a humped back, especially in elderly women.

This disorder (called kyphosis or a “dowager’s hump”) is an exaggeration of your spine that causes the shoulders to slump forward and the top of your back to look enlarged and humped.

Trauma to the spinal vertebrae can also lead to minor or severe fractures. Such trauma could come from a fall, a forceful jump, a car accident, or any event that stresses the spine past its breaking point.

Another cause of vertebral fractures is a metastatic disease. Metastasis is a term that refers to the spread of cancer cells into other areas of the body. The bones of the spine are a common place for many types of cancers to spread.

A compression fracture of the spine that appears for little or no reason may be the first indication that an unrecognized cancer has spread to the spine. The cancer causes destruction of part of the vertebra, weakening the bone until it collapses. This is a sign that something going on internally is harming the bones.

Compression Fracture | Cedars-Sinai

Not what you’re looking for?

What is a compression
fracture?

A
compression fracture is a type of fracture or break in your vertebrae. The vertebrae
are
the bones in your back that are stacked on top of each other to make your spine. Your
spine supports your weight, allows you to move, and protects your spinal cord and
the
nerves that go from it to the rest of your body.

Compression fractures can cause the vertebrae to collapse, making them shorter in
height. This collapse can also cause pieces of bone to press on the spinal cord and
nerves, decreasing the amount of blood and oxygen that gets to the spinal cord.

What causes a compression
fracture?

Osteoporosis is the most common cause of compression fractures. Osteoporosis is a
type of bone loss that causes bones to break easily.

Other
causes include injuries to the spine (such as from car accidents and sports injuries)
and tumors in the spine. The tumor may start in the vertebrae. But more commonly it
spreads there from another part of the body to the bone.

Who is at risk for a compression
fracture?

Osteoporosis is the most common cause of compression fractures. Preventing and treating
osteoporosis is the best way to decrease your risk for compression fractures. Most
compression fractures linked to osteoporosis are found in women, especially after
menopause. But older men develop osteoporosis and compression fractures, too.

People who have had one compression fracture related to osteoporosis are at a higher
than average risk of having another one.

What are the symptoms of a
compression fracture?

When
compression fractures first start developing, they may not cause symptoms. A healthcare
provider may discover them on an X-ray that you had done for other reasons. Later
symptoms may include:

• Slowly
  worsening back pain—lying on your back may relieve the pain and standing may make
  it
  worse
• A decrease in your height
• Limited movement in your spine (unable to bend or twist)
• A
  stooped-over posture, called kyphosis. Often, the front side of the vertebra loses
  height, but the rear side doesn’t. As a result, these fractures can cause your
  posture to stoop forward over time.
• Numbness or tingling, weak muscles, problems walking, and possible trouble controlling
  your bowels or bladder because of nerve damage

If the fracture happens rapidly, you may feel sudden, severe, disabling back pain.

How is a compression fracture
diagnosed?

Your
healthcare provider will talk with you about your health history and recent injuries,
and do a physical exam. They will check to see where you have pain and whether your
upper spine is hunched forward. The healthcare provider may also want to get pictures
of
your spine using X-rays, CT scans, or MRI.

If
your healthcare provider suspects osteoporosis, you may need a bone density scan.
This
is a special type of X-ray called a dual-energy X-ray absorptiometry (DEXA). These
tests
show if osteoporosis is the cause of the fracture.

How is a compression fracture
treated?

If
your compression fracture is related to osteoporosis, your healthcare provider will
want
to treat the osteoporosis. You may need to take bone-strengthening medicine and calcium
and vitamin D supplements. Physical therapy and exercises may be recommended, too.
These
things help make your bones stronger and can help prevent other fractures.

Other types of treatment include:

• Pain medicine to relieve your back pain
• Bed rest for a short time, followed by limited activity while your bones heal
• Wearing a back brace
• Physical therapy to help you move better and strengthen the muscles around your spine

Different types of surgery are available and may be needed if other treatments aren’t
helping:

• Vertebroplasty. Using an X-ray for guidance, your surgeon uses a small
  needle to inject special quick-setting cement into your fractured vertebra. The
  cement provides support for the broken vertebra, strengthens the area, and usually
  results in pain relief.
• Kyphoplasty. This surgery is a lot like vertebroplasty. But before the
  cement is injected, small balloons are used to expand the fractured space to help
  make the vertebra taller. The balloons are removed, and then the empty space is
  filled with cement.

If a
cancerous tumor is causing your symptoms, you may need radiation therapy as well as
surgery to remove some of the bone and treat the tumor. If an injury has caused the
fracture, you may need surgery to repair the bone and join vertebrae together. This
is a
procedure called fusion.

What are possible complications of
a compression fracture?

Complications of compression fractures include:

• Fractured bones that do not heal after treatment, which can lead to damage of the
  nearby vertebrae
• Blood clots in the legs due to decreased mobility
• Kyphosis (a deformity also called dowager’s hump or humpback) that can lead to severe
  pain and problems with organs in the chest (such as the heart, lungs, and digestive
  organs)
• Spinal cord or nerve problems
• Chronic (long-lasting) pain

What can I do to prevent a
compression fracture?

Preventing osteoporosis, or treating it if you have it, is the best way to help prevent
compression fractures. Talk with your healthcare provider about a bone density test
to
see if you are at risk for osteoporosis, and then find out what you can do about it.
To
reduce your risk for osteoporosis and certain types of cancer, don’t smoke and limit
alcohol use. Doing weight-bearing exercises to strengthen your muscles and bones,
and
balance exercises to reduce your risk of falling are important, too.

If you have osteoporosis and want to start an exercise program, check
with your osteoporosis specialist first. Exercise is critical to overall health. But
you
may need to not do certain exercises or change them. This depends on how severe your
osteoporosis is.

Living with a compression fracture

Compression fractures caused by osteoporosis usually become less painful with medicines
and rest. They usually heal within 3 months. But some can cause long-term problems.
Medicines to treat osteoporosis can help prevent fractures in the future, but they
don’t
help heal an existing fracture. If you have osteoporosis, it’s best to treat it before
you develop any compression fractures.

In
most cases, compression fractures caused by injuries heal in about 8 weeks. But it
can
take longer if surgery is needed.

Compression fractures caused by cancer have varying outcomes depending on the type
of cancer and how well it responds to treatment.

When should I call my healthcare provider?

Call your healthcare provider if:

• You
  have back pain and think you may have a compression fracture, especially if you know
  you have osteoporosis, have had an injury to your back, or have cancer
• Your
  symptoms (such as pain, limited movement, numbness) keep getting worse
• You
  have trouble controlling your bladder and bowel function

Key points about a compression
fracture

• A
  compression fracture is a type of fracture or break in your vertebrae (the bones that
  make up your spine).
• Osteoporosis is the most common cause of compression fractures. Other causes include
  injuries to the spine and tumors.
• Preventing and treating osteoporosis is the best way to decrease your risk for
  compression fractures.
• When
  compression fractures first start developing, they may not cause symptoms.
• Treatment of compression fractures may include medicine, rest, a back brace, or
  physical therapy. Sometimes, surgery is needed.
• The risk of new fractures can be reduced by doing regular
  weight-bearing exercises that increase strength, and balance exercises that reduce
  the risk for falls.
• If you have osteoporosis, check with your osteoporosis
  specialist before starting an exercise program.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells
  you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
  or tests. Also write down any new instructions your provider gives you.
• Know
  why a new medicine or treatment is prescribed and how it will help you. Also know
  what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that
  visit.
• Know how
  you can contact your provider if you have questions.

Medical Reviewer: Thomas N Joseph MD

Medical Reviewer: Marianne Fraser MSN RN

Medical Reviewer: Raymond Kent Turley BSN MSN RN

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Not what you’re looking for?

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.

90,000 Treatment of crushed fractures of the lower thoracic and lumbar vertebrae

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Treatment of crushed fractures of the lower thoracic and lumbar vertebrae

Fractured vertebral body fracture accompanied by tears
intervertebral joints, compressed by the roots, and in some cases
spinal cord.All this causes constant pain even after complete
reduction of the fracture. Displaced fragments with a crushed fracture well
are adjusted in the same way (overextension), as with compression
fractures, and are held in a plaster corset. Such a fracture heals
not earlier than after 6 months. After removing the plaster cast, often
pains appear; the removable corset has to be applied again sometimes on
9-12 months Constant pain, discomfort and weakness that
occur with fragmented fractures with damage to the intervertebral discs,
causing further degenerative changes in the intervertebral and
inter-articular joints, completely disappear only after complete
intervertebral ankylosis of the damaged vertebra with above and below
vertebrae.The ankylosing process has been going on for several years. therefore
in some cases, especially with severe fragmented fractures,
it is advisable to achieve early ankylosis by surgery
the corresponding vertebrae.

Surgical fixation of the spine in case of fractures of the bodies of the lower thoracic and
lumbar vertebrae without spinal cord injury

Indications for surgery are available for fractures with a significant wedge-shaped
compression, with fragmented fractures of the vertebral body, with
anterolateral compressions, with fractures with concomitant injury
intervertebral discs, as well as for fractures of the arches with displacement. The operation is shown both at an early and at a later date, when
pain remains. To do this, you need to connect at least three vertebrae:
damaged 1-2 overlying and 1 – 2 underlying.

Immediately before the operation, it is necessary to establish the localization
spinous process of the damaged vertebra. To this end, into it for
a small metal nail or needle is inserted into the landmark and
lateral x-ray. The left needle allows
the operation time is easy to establish when compared with the radiograph
position of the spinous process of the damaged vertebra, fixation
the spine is performed under local or general anesthesia.Spinous
processes and arches of the corresponding three vertebrae are exposed along the median
lines and separate the periosteum.

Fixation with metal plates. Special awl, point
which is located at right angles to the handle, drilled spinous
processes of the vertebrae to be fixed. On both sides of the spinous
the processes are laid with metal plates (Fig. 28). Through the plates
and the spinous processes pass the bolts, which are screwed in with nuts.The wound
sutured in layers. No additional plaster cast is required.
Patients begin to walk in 2-3 weeks. Do medical gymnastics
follows from the first days after surgery. The plates are removed no earlier than
in a year. The results of the operation are quite satisfactory; the pains disappear and
patients return to their work. Some patients started to work
1.5-2 months after surgery.

Fig.28. Fixation of dislocation fracture of the II lumbar vertebra with significant
compression with two metal plates on both sides
spinous processes.

Other types of fixation. Ya.L. Tsivyan (1965) fixes
the damaged spine using a fixator – “tie” for the spinous
processes (Fig. 29). For this purpose G. S. Yumashev and L. L. Silin (1965)
use lavsan tapes.J. Havlin

(1961), P. Novak (1963), V. Wilkins (1965) and others use wire and
screws for back fixation. We are with fracture-dislocation of the lumbar vertebrae
to reduce the fixation of the spine, two
fixator Kazmin.

Ya.L. Tsivyan (1971) with compression fractures with damage
intervertebral disc, which he called “penetrating”, as well as
comminuted fractures of the vertebral bodies recommends the anterior partial
spinal fusion (Fig.thirty).

Fixation with bone grafts. Grooved chisels remove
cortical bone from the arches and lateral surfaces of the spinous
processes. The resulting bone chips are not removed. On the temples
bone grafts are placed, which are taken from the iliac crest
bone or from the tibia. The cracks are filled with cancellous bone
shavings. Bone homografts can be used for the same purpose.
After the operation, a plaster corset is applied for 4-6 months.Then appoint
wearing an orthopedic corset for up to 1 year.

Fig. 29. The position of the retainer-“tie” on the spinous processes according to Tsivyan
(diagram).

Fig. 30. Compression comminuted fracture of the body of the lumbar vertebra
(diagram). a – before the operation; b – after the operation of partial resection and
partial replacement according to Tsivyan.

In some cases, we combine fixation of the spine with metal and
bone plates.

With significant compressions of the thoracic and lumbar vertebrae Ya.L. Tsivyan

(1971) applies partial replacement of the vertebral body.

Fractures of the upper and middle thoracic vertebrae

Fractures of the upper and middle thoracic vertebrae in most cases
accompanied by slight to moderate compression.A significant
compression, as a rule, is not observed. Fractures in this section
the spine is practically impossible to reclinate. Wedge deformation
vertebra here due to the inactivity of the upper and middle thoracic
vertebrae rarely causes severe pain.

Treatment. The same as described above for fractures with small and
moderate compression.

Fractures of the arches of the vertebrae

Fracture of the arch without displacement and with displacement occurs as a result
overextension and rotational-flexion mechanism.It is always necessary
not only X-ray examination, but also neurological.
The danger of shearing with such fractures is great and may be
catastrophic in the sense of the possibility of spinal cord injury.

Treatment. For fractures without displacement, a plaster corset is applied in
upright position of the patient. Stretching at the time of applying a corset
carry out behind the head. Fixation should be done in a neutral
position (no flexion or extension) The first 6 weeks, the patient should
be in a corset and stay in bed.The corset is removed after 3-4
month

With fractures of the arches, the displacement occurs anteriorly; due to instability
these fractures show primary fixation of the vertebrae.

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Bone fracture treatment | ChUZ “KB” Russian Railways-Medicine “them. ON THE. Semashko “

Fractured – we – bone damage, which is accompanied by a violation of its integrity. Rarely are congenital fractures, which usually occur with various hereditary diseases of the skeleton, leading to a decrease in its strength. Acquired Fractures. occur as a result of the action of mechanical force on the bone, if its value exceeds the strength of the bone tissue.Under the action of excessive simultaneous force (blow, fall, gunshot wound, etc.), a so-called traumatic fracture occurs, and in painful conditions accompanied by a decrease in bone strength (osteomyelitis, tumor, some endocrine diseases, etc.), the fracture occurs when exposed to significant less force or spontaneously and it is called pathological. They appear without much violence, even in a dream. First aid for these fractures. the same as for traumatic ones.

In case of fractures, along with damage to the bone, the integrity of the surrounding soft tissues is disturbed, nearby muscles, blood vessels, nerves, etc. can be injured. In case of concomitant fracture, skin damage and the presence of a wound, the fracture is called open, and if the skin is intact, closed. Depending on how the fracture line of the bone passes, there are transverse, oblique, longitudinal fractures. If the bone breaks completely and splits in two, it is a simple fracture (but it can be very difficult to treat).When one or more fragments are separated from the bone, the fracture is called comminuted or multi-comminuted, but if there are a lot of fragments, then this is a fragmented fracture. Sometimes the bone breaks partially, that is, a crack is formed – an incomplete fracture. Complete fractures are very often accompanied by displacement of bone fragments in different directions. This usually occurs as a result of muscle contraction following an injury. In old and senile age, when bone strength decreases and coordination of movements worsens, fractures.occur more frequently. A special place is occupied by compression fractures (usually of the vertebral bodies), in which the bone is not separated, but flattened.

The most common fractures of long tubular bones – humerus, ulna, radius, femur, tibia. Typically, it is not difficult to recognize a fracture. After the injury, a sharp pain appears, the victim cannot move the limb, its shape is disturbed or the length changes in comparison with the healthy side. Sometimes the victim hears a crack of a breaking bone, after which unusual mobility appears, for example, in the middle of the lower leg with a fracture of both tibia.Unlike a lighter injury, for example, with a bruised limb or joint, the function is not impaired gradually, but immediately. However, there may be exceptions, especially for incomplete fractures. A complete fracture, as a rule, is accompanied by extensive hemorrhage into adjacent tissues, and when bone fragments are displaced, vessels and nerves are often also damaged. In such cases (with damage to the limbs), blanching, coldness of the hand (foot) is noted, the sensitivity of the skin is disturbed and, if blood circulation is not urgently improved (blood supply is restored), then severe complications may develop.In a number of fractures, adjacent organs are damaged. So, with a fracture of the ribs, the lung may suffer (hemoptysis appears), with a fracture of the spine, the spinal cord (paralysis occurs), with a fracture of the pelvis, the bladder (blood appears in the urine).

The process of fusion of bone fragments after a fracture is long. Initially, the site of bone destruction grows with young connective tissue, which forms the so-called soft callus, which gradually turns into a stronger callus.To ensure rapid fusion of bone fragments, it is necessary to create rest for them and ensure their contact. The timing of the healing of fractures of various bones differs significantly. So, the phalanges of the fingers grow together for several weeks, and the neck of the femur – 6 months. and more. With too great a distance between the fragments, wedging of soft tissues between them (the so-called interposition), insufficient rest, with some concomitant diseases and as a result of other reasons, the process of fusion of fragments slows down or stops altogether.If the displacement of the fragments was not eliminated in a timely manner, the fracture may heal incorrectly – with deformation, shortening of the limb, etc. Healing of open fractures is especially difficult if infectious agents have penetrated through the wound.

When providing first aid, in no case should you try to match the bone fragments – to eliminate the change in the shape of the limb (curvature) with a closed fracture or to set the bone that has come out in the open fracture. The victim must be taken to a hospital as soon as possible. Beforehand, it is necessary to ensure reliable transport immobilization, and in case of an open fracture, also apply a sterile bandage to the wound. In the event of severe bleeding (Bleeding), measures must be taken to stop it, for example with a hemostatic tourniquet. If for the period of transportation it is necessary to insulate the victim, then it is advisable to simply wrap the injured limb or leave it under the clothes thrown on top (hand under the coat, etc.). If it is necessary to undress the victim (this can be done only in cases where there is no danger of displacing the fragments), first remove the clothes from the healthy side, and then on the side of the injury; dress in reverse order.It is possible to carry a victim with a fracture only over short distances and, preferably, on a stretcher.

After removing the displacement of the fragments, they are fixed until fusion in the correct position using a plaster cast or a special apparatus. If it is impossible to match the fragments, an operation is performed. Sometimes various metal structures are used to fasten the fragments. A plaster cast by your doctor may loosen as a result of reduced swelling or become tight if the swelling at the fracture site has increased.If signs of compression appear (pain, pallor or cyanosis of the fingers), you should immediately consult a doctor again, and not try to do anything with the bandage yourself.

Treatment of bone fractures is carried out after consulting a specialist. In the absence of displacement of fragments – conservative treatment, in the presence of displacement of fragments or the threat of displacement, surgical methods of treatment are used.

90,000 Fracture of the cervical spine – causes, symptoms, diagnosis and treatment

Fracture of the cervical spine – violation of the integrity of one or more cervical vertebrae as a result of traumatic impact.It occurs as a result of a blow, a fall on the head, a sharp bend or extension of the neck. It manifests itself as pain in the neck, limitation of movement and spastic muscle tension. Often, neurological symptoms of varying severity are detected. The diagnosis is made on the basis of X-ray data, if necessary, CT and MRI are additionally prescribed. Treatment is often conservative; if the spinal cord is injured, surgery is required.

General

Fractures of the cervical vertebrae account for about 30% of the total number of vertebral fractures.At the same time, in 40-60% of cases, there is damage to the spinal cord of varying severity. About 30% of patients with such fractures die on the spot due to shock, as well as severe respiratory and cardiac disorders caused by damage to nerve structures. The majority of patients with fractures of the cervical spine are active young and middle-aged people.

The cause of injury is usually a fall on the head from a height, diving into the water in not deep enough places, a sharp bend (less often – extension) of the neck when suddenly braking a vehicle, or hitting the head on the roof of a car when driving on a bad road.Compression fractures of the IV, V and VI vertebrae are most often detected, however, the most severe consequences occur with fractures of the I and II vertebrae. Treatment of fractures of the cervical spine is carried out by traumatologists.

Fracture of the cervical spine

Fracture of the atlas

I cervical vertebra (atlas) looks like a ring and is a kind of “base” on which the head rests. With its concave surfaces, it articulates with the convex condyles of the occipital bone, forming a joint with thin cartilaginous surfaces, a capsule and ligaments.There is no thick cartilaginous lining (intervertebral disc) between the occipital bone and the 1st cervical vertebra, therefore, upon impact with the head, the traumatic force is transmitted to the atlas without amortization.

The condyles of the occipital bone are pressed into the atlas ring, and, depending on the severity and axis of application of the traumatic force, several types of fractures can occur. Fracture of the anterior arch – isolated damage to the anterior half-ring, may be accompanied by a more or less pronounced displacement of fragments.Posterior arch fracture is an isolated injury to the posterior semicircle, usually stable, without significant displacement and compression of the nerves. Fractures of the lateral masses – a violation of the integrity of the central parts of the ring, accompanied by a decrease in the height of the vertebra.

The most severe Atlas injury is a “bursting” fracture or Jefferson’s fracture, in which the integrity of the Atlas ring is broken at four points at once. There are also variants of “bursting” fracture, in which there is an explosive injury to either the anterior or posterior arch of the atlas, or parallel fractures of the posterior and anterior arch.Atlanta trauma can be isolated or combined with damage to the II cervical vertebra and other vertebral segments.

The patient is worried about the feeling of instability of the neck, pain in the neck, crown and back of the head, loss of sensitivity in the parietal and occipital region is possible. The patient holds his head with his hands. When nerve structures are damaged or compressed, neurological symptoms are detected. Radiography of the 1st cervical vertebra in a special projection (through the mouth) allows you to confirm the violation of the integrity of the atlas and assess the degree of displacement of the arcs.If necessary, CT is additionally prescribed. Patients with suspected damage to the spinal cord or medulla oblongata are examined by a neurosurgeon or neurologist.

Axis fracture

II cervical vertebra (axis) also has the shape of a ring. In the anterior sections of this ring, there is a massive bony outgrowth called a tooth. The tooth connects to the posterior surface of the atlas, forming the Cruvelier joint. In addition, the atlas and axis are articulated with each other using wide and flat symmetrically located articular surfaces.Due to the structural features of the upper spine, the odontoid process usually suffers from injuries. Three types of tooth fractures can be identified. The first type is avulsion damage to the apex of the tooth, a rare stable fracture. The second type – damage to a narrow part of the tooth, an unstable fracture, is observed in more than 50% of cases. The third type is damage to the base of the tooth, in 20% of cases it is accompanied by neurological disorders.

Taking into account the degree of displacement of the atlas and the severity of symptoms, three degrees of fracture of the odontoid process are distinguished.At the first degree, there is no displacement, the patient complains of discomfort in the neck and minor pain during head movements. In the second degree, the atlas and the fragment of the tooth are displaced anteriorly, and the posterior part of the 1st vertebra compresses the spinal cord. Loss of consciousness is possible during an injury or some time after it, neurological symptoms are revealed – from minor disturbances in sensitivity to paresis and paralysis. In the third degree, due to a significant displacement, severe damage to the nerve structures usually occurs, incompatible with life.

It should be borne in mind that false well-being in first-degree fractures can provoke an underestimation of the severity of the injury (both by the doctor and by the patient himself). The patient moves freely, turns his head, shakes his head, etc. With such movements, sometimes there is a sharp displacement of the atlas and sudden compression of the spinal cord, accompanied by acute compression myelopathy and a sharp deterioration in the patient’s condition. Given this circumstance, all axis fractures should be considered as potentially dangerous injuries.

To confirm the diagnosis, radiography is performed in two projections: lateral and oral. If the results are uncertain, it is possible to perform functional images (with the utmost care and in the presence of a doctor), however, axial CT with frontal and sagittal reconstruction is a safer and more informative method of investigation. For neurological disorders, a consultation with a neurologist or neurosurgeon is prescribed.

CT of the cervical spine. C2 transverse fracture without displacement of fragments.

Fractures of the lower cervical vertebrae

Compression and fragmented fractures of the cervical spine in most cases occur with forced flexion of the neck (flexion fractures). Less common injuries due to abrupt extension of the neck (extensor fractures). Patients complain of pain in the cervical spine. Movement is limited. Spastic contraction and tension of the neck muscles is determined. Palpation of the spinous process of the fractured vertebra is painful.

In some cases (with a rupture of the ligaments between the spinous processes), a curvature of the line of the spinous processes in the form of a bayonet or a lightning is revealed. This sign indicates the instability of the fracture. Compression fractures are usually not accompanied by damage to the spinal cord, while mild neurological symptoms may be observed due to edema of the affected area. In case of spinal cord injury (more often occurs with fragmented fractures and fracture dislocations), neurological disorders are more pronounced, in severe cases tetraplegia, violation of the act of defecation and urination are detected.

Particularly severe injuries are dislocation fractures of the cervical vertebrae, which also usually occur as a result of sharp bending of the head. With fracture dislocations, simultaneous damage to several vertebrae, fractures of the arches, spinous and articular processes are often found, complete paralysis and loss of sensation often occur. Death is possible immediately after damage, after several hours or several days. In the latter case, respiratory disorders, pulmonary edema and other complications become the cause of death.

Radiography of the cervical spine is of decisive importance in the diagnosis. Particularly informative is a lateral image, which can reveal compression (a decrease in the height of the anterior parts of the vertebra) and an increase in the gap between the spinous processes of the broken and overlying vertebrae. In doubtful cases, a CT scan of the spine in the cervical spine is prescribed; MRI of the spine is used to assess the state of soft tissue structures. In the presence of neurological disorders, consultation with a neurosurgeon or neuropathologist is indicated.

Treatment

In most cases of cervical vertebral fractures, conservative treatment is indicated. Patients are admitted to the trauma department. For uncomplicated fractures without displacement, immobilization is carried out using a Shants-type collar, a plaster corset or a rigid collar for up to 4 months. In the presence of displacement and the danger of spinal cord injury, traction with a Glisson loop is used in combination with corrective pillows or rollers.

For flexion fractures, a pillow is not placed under the head; a roller is placed under the shoulders.In case of extensor injuries, two pillows are used, placed under the patient’s head; after the compression is removed, the pillows are removed. After 15-30 days, the traction is removed and a rigid collar or plaster half-corset is applied for a period of 3-4 months. Patients are prescribed pain relievers, physiotherapy procedures and therapeutic exercises.

Surgical interventions are performed for unstable fractures and dislocation of the cervical vertebrae (especially in combination with compression or damage to the spinal cord), comminuted compression fractures, as well as in case of ineffectiveness of conservative treatment.Laminar contractors, transarticular fixators or plates are used to fix the vertebrae. In the postoperative period, antibiotics, analgesics, exercise therapy, massage and physiotherapy are prescribed, followed by rehabilitation measures.

90,000 Fracture of the lumbar spine – signs, causes, symptoms, treatment and prevention

Diagnostics

After identifying such symptoms, the victim is immediately sent to the consultation of a traumatologist, who conducts a visual examination of the patient and examines the anamnesis.To accurately determine the diagnosis, the patient is sent for an X-ray examination carried out in two projections. The lateral image is very informative, which can show whether the height of the anterior vertebral sections has decreased. They also practice computed tomography and magnetic resonance imaging. In some cases, the patient is sent for electrophysiological examination, myelography, and sometimes for CSF tests.

It is also necessary to make an appointment with a neurologist or neurosurgeon to determine or exclude damage to the nerve processes.

Treatment

Therapeutic therapy depends on the complexity of the problem. Everyone, without exception, is given a paravertebral blockade. For moderate violations, a two-month bed rest is prescribed (under the mattress – a shield, under the lower back – a small roller).

With complex compressions, a gradual reclination is made (placing rollers), then a corset made of plastic or plaster is installed. This method is more easily tolerated by patients and rarely provokes intestinal problems. If the obstruction is strong, then the stomach is washed and enemas are given.

Fracture dislocations and comminuted fractures involve the use of skeletal traction. When the dislocation is adjusted, reclination is performed and the corset is installed.

Surgical intervention is used for instability of the vertebral part of the skeleton and compression phenomena of the nervous system. During the operation, osteosynthesis with metal structures is sometimes performed.

Prophylaxis

With relatively simple injuries, physical therapy is immediately prescribed, after a while – thermal and massage measures.A set of exercises for physiotherapy exercises is prescribed for fracture dislocations and injuries with fragments.

After surgery, antibiotics, pain relievers, therapeutic exercises and physiotherapy are recommended.

In each case, it is necessary to take control X-rays to assess the correct fusion of the bones.

Literature and sources

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90,000 In the village of Podgorensky, the mother of a 19-year-old boy with a spinal injury asked for help

A resident of the village of Podgorensky, Yekaterina Pletneva, asked for help in treating her 19-year-old son Ivan Goncharov.He has a fracture of the cervical spine and needs a long rehabilitation after the operation. This was reported to the RIA Voronezh correspondent by the boy’s mother on Monday, July 20.

An accident occurred on the pond in the Repyev farm on 13 July. Ivan rested there with friends.

– He unsuccessfully jumped from a bridge into a body of water. It turned out to be shallow there, and Vanya hit his head on the bottom. A friend pulled him ashore, and we called an ambulance, ”Ksenia Titarenko told the RIA Voronezh correspondent.

Ivan was taken from the Podgorenskaya regional hospital to Pavlovsk on the same day at 23:00. Already on July 15, he was taken by helicopter to the regional clinical hospital No. 1 and underwent an operation. Today the guy should be transferred from the intensive care unit to the surgical department. The mother was allowed to stay with her son in the ward all the time.

– The operation was difficult, one of his cervical spine was completely crushed, and an implant was placed. The son is conscious, but he has difficulty breathing, the doctors do not give any predictions yet.Treatment is possible only in a hospital setting, subject to strict bed rest. Doctors say that a long rehabilitation is needed. Vanya will need a supporting and fastening corset around his neck, its cost is from 10 thousand and more. You also need money to stay in the hospital. We have no relatives in Voronezh to stop, – said Ekaterina Pletneva.

The family will also need to buy hygiene products that help cope with pressure ulcers. The large Pletnev family does not have such funds.Ekaterina works in a kindergarten as a teacher’s assistant, her husband works as a machinist at a cement plant. The young man graduated from the Rossoshansk Chemical and Mechanical College, defended his diploma as a welder with excellent marks, but did not manage to get it.

Anyone who wants to help Ivan Goncharov can transfer funds to the Sberbank card by phone number 8 908 140 83 87 (Ekaterina Petrovna P.).

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Injuries, fractures

Injuries and accidents are a reality that awaits us on the street and on the road, at work and at home.It is impossible to completely protect yourself from damage, but you can reduce their consequences as much as possible by timely seeking qualified medical help from traumatologists.

Our clinic is equipped with the most modern medical equipment, which allows us to provide accurate diagnostics of injuries of the musculoskeletal system – from clinical examination to performing X-ray, ultrasound, computed tomography examinations and to reveal the smallest violations of the structure of bones, joints and tendons, as well as to perform high-tech surgical interventions of any complexity using minimally invasive techniques…. We have developed a technology that includes preoperative preparation with examination by carrying out X-ray and computed tomography studies, techniques of surgical intervention and postoperative administration of patients with rehabilitation.

Treatment

In the treatment of fractures, 2 main points must be performed – reduction (comparison of bone fragments in the correct position) and subsequent fixation of the fragments for the entire period of fusion.

The most ancient method of treating fractures, which has not lost its relevance to this day, is conservative treatment – manual reduction of the fracture with subsequent immobilization (immobilization) in bandages made of solid materials (most often of plaster).In our clinic, instead of plaster, we use bandages made of solid polymer materials (tape-caste, soft-caste). These dressings are devoid of the disadvantages of plaster: they are lightweight, are not afraid of moisture and are more functional.

But often a more reliable and convenient method for treating a fracture is an osteosynthesis operation.

Osteosynthesis (osteosynthesis, Greek osteon bone + synthesis connection) is the connection of bone fragments. The purpose of osteosynthesis is to ensure firm fixation of the matched fragments until they are completely fused.

There are two main types of osteosynthesis.

1. Internal (immersion) osteosynthesis is a method of treating fractures using various implants that fix bone fragments inside the patient’s body. Implants are pins, plates, screws, wires, wires. Implants are made of metal resistant to oxidation in the internal environment of the body (stainless steel, titanium alloys, molybdenum-chromium-nickel alloys.The surface of bone implants can be smooth, polished or have special pores for the possibility of ingrowing into body tissues.
2. External (transosseous) osteosynthesis, when bone fragments are connected using distraction-compression external fixation devices (the most common of which is the Ilizarov apparatus). In Russia, the Ilizarov apparatus is traditionally used as the most functional, convenient and reliable external fixation apparatus. G.A. Ilizarov was the first to invent an apparatus in which crossed spokes, passed through bone fragments, were fixed in a taut state to annular supports.In this case, the device is outside the patient’s body.

The method of transosseous osteosynthesis allows:

1. to carry out extrafocal fixation of the fracture (the wires pass above and below the level of the fracture, leaving the fracture zone and soft tissues above it intact
2. to correct the position of fragments during treatment, staged reduction
3. to act on the callus by distraction and compression, to stimulate bone fusion
4. lengthen the limb by forming a distraction regenerate (this is the basis of the method of increasing growth using transosseous osteosynthesis)
5. to fix the most complex fractures (multi-splintered, fragmented, etc.)n.)

In our clinic, operations are also performed using the most modern internal fixators – plates with angular stability, intramedullary pins with blocking, allowing to achieve the fastest possible rehabilitation of patients.

The highly qualified traumatologists of our clinic will allow us to cope with any damage to the musculoskeletal system, to ensure the rapid restoration of functional mobility and the return of patients to their usual activities.Not sure where to treat your injury? Make an appointment with us!

Treatment of hip fracture

Description of the disease, symptoms and causes, methods of treatment.

Fracture of the femoral neck is a dangerous condition of the human body caused by a fracture of the femoral neck, localized at the place of attachment of the femur and its head (the latter is involved in the formation of the hip joint). Evolutionarily, it has developed that the hip joint experiences the greatest loads associated with upright posture.It is obvious that any violation of the integrity of the support structures nullifies the free movement.

If a patient has a hand injury, then he loses only some of his work activity, but when the legs and, in particular, the hip joint are turned off from work, social activity is reduced to a minimum. A hip fracture is dangerous for its somatic complications, especially in the elderly. The misconception that this kind of injury occurs only in persons whose bone tissue is fragile and inelastic, i.e.e. in old age. Young able-bodied citizens are also in the same risk zone for a hip fracture, they are also bedridden and, to the same extent, they require qualified medical care.

The fracture of the femoral neck itself anatomically leads to a violation of the trophic function of the femoral head, which is further complicated by its necrosis and, as a consequence, imposes serious adjustments in treatment, narrowing the methods of surgical intervention.

Complications

Any pathological processes acquired and congenital in traumatology, in one way or another, are directly related to the limitation of mobility and movement of a person as a whole.Damage to a limb is associated with its immobilization, but not a ban on the movement of the person himself, on the contrary, an injury to the hip joint, its complete exclusion from the motor and support function leads to strict bed rest. A long-term recumbent lifestyle does not bode well for any prospects, whatever the age of the victim. Persons with hip fractures are in a special risk zone for pneumonia, phlebothrombosis, heart failure, etc. Complications that have arisen against the background of a hip fracture can be fatal to the body, which is why in any age group this or that treatment is meant. full or partial return of motor activity.According to statistics, about 80% of all victims die from complications of a hip fracture in the first three years, which is comparable only with blood diseases, in particular, leukemia and lymphomas in hematology.

Treatment

As already mentioned, a hip fracture is a formidable injury that occurs at any age and requires urgent treatment at any age. Based on this, doctors have developed various conservative and surgical techniques, as a rule, mutually complementing each other.

Conservative treatment of a hip fracture in isolation is currently practically not used due to the lack of proper effectiveness. Earlier, in the absence of proper technological inventions in practical traumatology, methods of plaster immobilization were widespread, tightly juxtaposing the very bone fragments, that is, the head of the femur and the neck itself. If necessary, under the visual supervision of a physician, manual comparison could be applied additionally if there was a suspicion of a significant discrepancy of the broken bone.This method of treating a hip fracture only increased the likelihood of healing; in old age it had even poorer efficacy. It is currently recommended for people who do not have the opportunity to perform a full-fledged operation now, for example, recent acute myocardial infarction, cerebrovascular accident and other contraindications to anesthesia. By the way, modern narcotic drugs and their methods of administration have completely different contraindications, narrower and less common, which gives a chance for patients, even with severe concomitant diseases, for a successful recovery.

Operative surgical treatment involves an open operation. There are two principal approaches:

Method 1 is less traumatic for the patient, economically more profitable and prognostically favorable, but is applicable only if adequate blood supply to the femoral head is maintained (see the anatomical features of the blood supply above). The essence of the method is to fix the bone fragments with screws that tightly hold the femur.Full immobilization is required only after the first week after the operation, then the patient begins to gradually perform exercises, move around the ward. From a clinical point of view, osteosynthesis of a hip fracture is more effective, but there are few such injuries involving its use. That is why the treatment of a hip fracture is most often carried out in a different way.

Method 2 consists in replacing the hip joint with an artificial one that is not inferior in its physiological parameters.The scope of the operation consists in removing the head and neck of the femur (implants are installed instead), and a screw is installed into the epiphysis itself, i.e., the thickness of the bone, tightly holding the new structure. This kind of treatment of a hip fracture seems from all points of view more complicated, but effective in any fracture, even when the bone fragments themselves are fragmented into many parts and their blood supply, of course, is absent. The joint replacement technology is quite expensive, requires the appropriate qualifications of surgeons-traumatologists, but is practically devoid of contraindications, taking into account modern achievements.It should be noted that an artificial hip joint with a hip fracture is installed at any age, both for children and at an older age.

Speaking about the treatment of a hip fracture, it is necessary to note possible complications from the medical manipulations themselves, in particular, we are talking about infectious complications, rejection of artificial structures during osteosynthesis and endoprosthetics, thrombotic lesions, etc.