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Basics of CT Scan Head and Trauma Radiographs
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Ujjwal Gorsi, Chirag Kamal Ahuja
Subcutaneous emphysema on chest radiographs creates radiolucent striations which outline fibres of the pectoralis major (Figure 29.12). Air can also spread to the head, neck and abdomen. Trauma to chest can cause various injuries to the skeleton. Injury to the brachial plexus and great vessels may be seen in association with upper rib trauma. Lower rib fractures may be associated with injuries to upper abdominal organs. Five or more contiguous single fractures or three adjacent segmental rib fractures will lead to flail chest. Respiration can be severely impacted as a result of paradoxical motion during respiration (Figure 29.13). Clavicle fractures are common and usually are not of much clinical significance (Figure 29.14). Sternoclavicular dislocations, scapular and sternal injuries may also be seen. Spinal fractures may cause neurologic and vascular damage.
Early versus Delayed Stabilization of Femoral Fractures: A Prospective Randomized Study
Published in Stephen M Cohn, Ara J. Feinstein, 50 Landmark Papers every Trauma Surgeon Should Know, 2019
LB Bone, KD Johnson, J Weigelt, Scheinberg R. J Bone Joint Surg Am
Bliemel C, Lefering R, Buecking B, et al. Early or delayed stabilization in severely injured patients with spinal fractures? Current surgical objectivity according to the Trauma Registry of DGU: Treatment of spine injuries in polytrauma patients. J Trauma Acute Care Surg. 2014; 76(2): 366-373.
Central nervous system
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
In conservative treatment the cervical spine can be immobilised using traction applied with skull tongs. This often entails prolonged bed rest although application of a halo body jacket allows some mobilisation. Surgical treatment involves open reduction and stabilization of spinal fractures along with spinal decompression. High dose steroids, vasopressor support (MAP > 85 mmHg) and therapeutic hypothermia have been explored but none are now routinely recommended.
Differences in management of isolated spinal fractures between neurosurgery and orthopaedics: a 6-year retrospective study
Published in British Journal of Neurosurgery, 2021
Matthew Myers, Samuel Hall, Ahmed-Ramadan Sadek, Christopher Dare, Colin Griffith, Emad Shenouda, Ali Nader-Sepahi
Spinal fractures are often caused by road traffic accidents, falls and recreational activities,1 while non-traumatic vertebral fractures are more commonly secondary to osteoporosis.2 Data on the incidence of spinal fractures are limited, but it is estimated to account for approximately 0.7% of fractures;3 around 300/1,000,000/year for osteoporotic spinal fractures and 54/1,000,000/year for spinal cord injuries.4,5 The prevalence of vertebral fractures is thought to be increasing due to the ageing population.6 Spinal fractures are costly7 and a poor outcome can have a significant impact on quality of life with 75% of patients with a stable spinal fracture continuing to experience persistent back symptoms.6 Up to 10% of patients never return to work following injury.7 Furthermore, approximately 5% of spinal fracture cases are associated with neurological injury1 which highlights the importance of appropriate initial management.6
Controversies regarding mobilisation and rehabilitation following acute spinal cord injury
Published in British Journal of Neurosurgery, 2020
Fardad T. Afshari, David Choi, Antonino Russo
Historically traditional practice of long bed rest (6 weeks or more) post spinal cord injury was adopted over the years for multiple reasons. These included conservative management of certain types of spinal fractures associated with spinal cord injury and therefore time necessary to allow for fusion and bony healing. Furthermore many patients following acute spinal cord injury have haemodynamic instability due to neurogenic shock and therefore maintaining blood pressure (BP) plays an important role in improving cord perfusion in acute phase of injury.3 In addition, patients can have episodes of symptomatic orthostatic hypotension which may limit their ability to mobilise early.4 Despite reasons above, with emerging new evidence, management of spinal cord injury has evolved significantly with shift towards active and early stabilisation following injury to allow early mobilisation after the acute i.e. 2 weeks following the injury. This early mobilisation has been adopted in many countries although traditional prolonged bed rest is still practiced in some spinal rehabilitation units across United Kingdom.
Hidden Blood Loss in Spine Surgery for A1-A3 thoracolumbar Fractures. Comparison Between Three Approaches
Published in Journal of Investigative Surgery, 2019
Spinal fracture is a common injury that most often occurs in the thoracolumbar spine. Traditional open posterior surgery for reduction and stabilization of unstable thoracolumbar fractures with pedicle screws is still nowadays the gold standard. However, traditional posterior approach requires splitting of the paravertebral muscles and ligaments, which is associated with perioperative bleeding, possibly increased infection rate, back pain, and delayed functional rehabilitation.1–3 The Wiltse paraspinal approach4, is associated with less bleeding and less tissue injury through dissection, and it was thought to minimize the negative consequences of the traditional open posterior approach since it was associated with good outcomes.