Transcript fracture type Malgenya

Damage to the spine, pelvis
PROFESSOR
Fishchenko Vladimir
Alexandrovich
 BASHINSKIY
PETROVICH
GENNADIY
Among spinal injuries
most noteworthy damage
to the vertebrae
themselves. Early
diagnosis of the spine is
very important to provide
the correct and timely
fast aid

Late diagnosis may cause
worsening of spinal cord injury
and quickly lead to secondary
damage to the spinal cord and its
roots
The cause of delayed diagnosis
of spinal injuries is usually
underestimating the severity of
the damage. It should be
remembered that the diagnosis
of a back injury, ligament
damage, etc. can be considered
only after it is completely
excluded the diagnosis damage
of the vertebral body
Damage to the vertebral bodies
are more common in the
indirect mechanism of injury:
the axial load on the spine,
sharp or excessive flexsion
and its extension .

Sometimes there may be two or even
three types of loads. For example, the
combination of a sharp flexion and
extension of the cervical spine when
hit by a car, braking, etc.

In adults, the most damaged by the
lower neck and upper chest vertebrae,
the lower thoracic and upper lumbar
vertebrae (the transition zone of one of
the physiological curvature of the
other).

Dislocation are more common in the
cervical region, while in the thoracic
and lumbar region we can see
fractures and fracture- dislocation.

Damage to the vertebral bodies are
divided into: stable and unstable. The
instability called those injuries for
which there is a tendency to shift the
vertebrae, which is observed in
posterior ligamentous complex
(interspinous, supraspinous, yellow
ligaments and intervertebral joints).

Rear ligamentous complex also
damaged at fracture-dislocations of the
vertebrae, with wedge compression by
more than half the height of the
vertebral body

Stable fractures are rarely associated
with the pressure of the contents of the
spinal canal, and in unstable injuries is
always a danger of such a
compression

It is also unstable so-called flexion rotation fracture. The most common
fractures of the vertebrae - wedge
compression and the abruption
anterosuperior and anteroinferior angle
- are stable fractures.
classification of fractures of
the spine in the degree of
compression

1 degree height of the vertebral body is reduced
to one-third
2 Degree - half
3 Degree - more than half
Diagnosis of vertebral
fractures and dislocations

The most common complaint of
patients early after injury is a pain in
the injured spine, which spans 2-3
vertebrae. Pain may be local or
radicular

When viewed from the back should
first pay attention to changes in the
physiological curvature of the spine.
True hump is rare, but the decrease of
lumbar lordosis or increase thoracic
kyphosis is often observed

In fractures the lumbar vertebrae can
be a pain in the abdomen and some
muscle tension anterior abdominal
wall. This is due to the presence of
retroperitoneal hematoma
accompanying fracture.
The presence of retroperitoneal
hematoma, irritation or damage to the
solar plexus and border symptomatic
trunk carried to the emergence of "
the clinic false "acute abdomen", which
can be so severe that sometimes have
to resort to a diagnostic laparoscopy or
laparotomy.

For the differential diagnosis between
the clinic false "acute abdomen",
abdominal syndrome in fractures of the
lumbar vertebrae and damage to the
organs of the abdominal cavity, you
can use vertebra anesthesia by
Shnek.

Anesthesia performed with the patient
on his side. 12-14 cm long needle is
introduced at 6 cm away from the
spinous processes of the lumbar
vertebrae and broken promote
vertebral body at an angle of 35
degrees to the plane of the back. At a
depth of 5-8 cm needle usually rests
on the transverse process. Surpassing
its top, the needle move further the
midline.

The movement of the needle precede
the introduction of a 0.5% solution of
novocaine. At a depth of 8-12 cm
needle rests in the body of broken
vertebra. Confirmation of this will leak
out of the needle novocaine stained
with blood. Here are administered 10
ml of a 1% solution of novocaine. The
needle is removed.

If after a few minutes of anesthesia by
Shnek you can notice regression of
symptoms of "acute abdomen", you
can think of that syndrome is caused
by a fractured vertebra.

Fairly constant symptom of spinal
injury is increased pain in the back
straight when lifting the leg with the
supine position. But this symptom is
characteristic not only of vertebral
fractures in the lumbar region, but also
for any back injuries in general,
including bruises, sprains and back
muscles etc

In order that would differentiate a
fracture of the body of the lumbar or
lower thoracic vertebrae from the back
of soft tissue injury and fractures of the
transverse processes, there should be
palpated spinous processes while
lifting straight feet from a lying position
on the back (a symptom of Silin).

The axial load on the vertebra is
allowed only with the patient lying in a
light tapping on the heels or the
pressure on the head. Rough axial
load on the spine and determination of
volume of movement especially in the
upright position of the patient, are not
allowed.

Conservative treatment:
Method of single repositioning followed
by the imposition corset;
Functional method;
The method of gradual repositioning
followed by the imposition corset

One-step repositioning is carried out at a
safe anesthetic. The simplest method is by
Boehler when Interspinous span over a
broken vertebra at a depth of 2-4 cm
injected 20 ml of 0.5% solution of
novocaine. Better pain relief reaches
properly performed anesthesia by Shnek,
but it is technically difficult and should not
be performed because of the budding
traumatologist possible complications. Local
anesthesia supplemented subcutaneous
analgesics
Fractures of the bones of the
pelvis

Damage to the bones of the pelvis is
4-7% of all fractures and are a group
of serious injury. Damage to the pelvis
may be accompanied by the most
severe shock caused by irritation of
the rich reflexogenic zones and
massive bleeding into the tissues of
the spongy bone (more than 2 liters)

One of the functions of the pelvis - the
transfer of the trunk load on the lower
limbs (supporting the pelvis) is due to
the integrity of the pelvic ring. Pelvic
ring formed by the sacrum, the body of
the ilium, pubic and ischial bones
(excluding the ischial tuberosity), pubic
and sacroiliac joint.
A. Boundary value
fractures

This damages the pelvic bones are not
involved in the formation of the pelvic
ring. This group includes broken spinal
process, tuber of ischium, coccyx,
transverse fracture of the sacrum
below the sacroiliac joint, fractures of
the ilium
Marginal fractures

The mechanism of injury is the direct
Fractures of the iliac wing, after brief
compression of the pelvis.
Fractures of the anterior spine may
be during heavy muscle tension.
Fractures of the sacrum below the
sacroiliac joint and coccyx occurs
when falling on the buttocks

By tearing the anterior spine, tenderness in
the area of ​separation, local swelling, a false
impression of shortening due to downward
and outward displacement of the fragment.
Symptom-Lozinski (reverse) when you try to bend the thigh during a
step forward there is a sharp pain in the
area of ​the fracture due to muscle tension
clip-on to the spine.
The movement kicked back is
significantly less pain, a patient walks back
B. Fractures of the pelvic ring
without breaking its
continuity

This bone fractures, forming the pelvic
ring. The strength of the pelvic ring is
reduced, but the reference is stored as
the two halves of the pelvis are
connected with the sacrum, both
directly and through the other half

These injuries include:
One or bilateral fractures same branch
pubic bone;
Single or bilateral fractures of the
ischial bones;
Fracture of one of the branches of the
pubic bone on one side and the other
of the ischium.
Fractures of the pelvic ring
without breaking its
continuity

The mechanism of injury-line.
Complaints: pain in the pubic area, in the
crotch on the side of injury.
Symptom-Gabai when turning from back
to side-step the patient maintains a
damaged side of the pelvis lower legs or
feet healthy side, turning from a lateral
position on the back of the patient keeps
this fixed position of both legs.
Symptom "stuck heel" - the patient can
not take his foot from the support line, but
keeps the limb elevated themselves
B. Damage to the violation of
the continuity of the pelvic
ring

In such injuries each half of the pelvis
is soldered to the sacrum with only one
side. Greatly disturbed the support
function of the pelvis.
Among these injuries :
Vertical fracture of the sacrum, or
fracture of the lateral mass of the
sacrum;
Rupture of the sacroiliac joint

Vertical fracture of the ilium;
. Fracture of both branches of the
frontal bone on one or both sides;
. Fracture of the pubic and ischial
bones on one or both sides (fracture of
the "butterfly");
. Rupture symphysis;

Damage to the solution of continuity
with simultaneous front and back halfrings (like Malgeniya). With this type of
injury is completely lost connection half
of the pelvis with sacrum. The support
function of the pelvis and half lost. Half
of the pelvis that is not related to the
spine (sacrum to), under the thrust of
the back muscles and stomach moves
up.

MAY BE
Bilateral fracture type Malgenya when
and the front and back D-rings are
damaged on both sides;
Unilateral or vertical, fracture type
Malgenya - fracture of front and back
half-rings on the one hand;
Oblique or diagonal fracture Melgenya
- the front half ring broken one, and the
rear - on the other side;
Fractures of the acetabulum:


rupture of the sacroiliac joint and
symphysis;
The combination of the symphysis
fracture with fracture back D-rings, or a
combination of rupture sacroiliac joint
with a fracture of the front D-rings
Fractures of the acetabulum:
Fracture edge of the acetabulum,
(with a dislocated hip, often caudineural)
Fracture of the bottom of the acetabulum,
(with central dislocation of the hip)

The mechanism of injury, the lateral
compression of the pelvis in the
trochanter.
The clinic is smoothed, X-ray
examination is mandatory.
Treatment-conservative-skeletal
traction. Acetabular fractures with
central dislocation of the hip-skeletal
traction is applied along the axis of the
thigh and the side of the greater
trochanter

Damage to the pelvis in most cases
accompanied by a shock. Feature
shock-trauma pelvis
except for the pain component,
there is significant blood loss
intrapelvic fat.
Prior to transportation to a hospital
is desirable to produce anesthesia
fractures and establish anti-shock jet
transfusion blood substitutes.

Pain management of fractures of the pelvis:
Intrapelvic anesthetic technique
In the position of the patient on the back of 1
cm from the anterior iliac spine after skin
anesthesia injected a needle length of 14-15
cm with a 0.25% solution of novocaine. The
needle is advanced from front to back. This
bevel of the needle should slide along the
inner surface of the ilium. At a depth of 1214 cm tip of the needle is in the iliac fossa,
here are administered 250-300 ml of a
0.25% solution of novocaine.
Damage to the simultaneous
violation of front and back halfrings (fracture type Malgenya)

The mechanism of injury-indirect.
On examination, pelvic asymmetry half, the
displacement of one of the halves of up to 2-3
cm
Determination of displacement-distance
compared to the xiphoid process to the anterior
spines on both sides.
Symptoms Varneylya and Larrey (sharp pain
when squeezed or dilution of of the iliac wing.)
treatment

Removing the patient from shock
intrapelvic anesthesia.

If displaced fracture, skeletal traction
for both lower limbs