Problems with bowel and bladder function may indicate a more serious spinal cord injury. The doctor may also check the tone of the anal muscles and determine whether the patient is able to empty his or her bladder without assistance. The patient's reflexes will also be tested to help determine whether there has been an injury to the spinal cord or individual nerves. This includes testing his or her ability to move, feel, and sense the position of all the limbs. The doctor will evaluate the patient's neurological status. This will include an inspection of the head, chest, abdomen, pelvis, limbs, and spine. The emergency room doctor will conduct a thorough evaluation, beginning with a head-to-toe physical examination of the patient. The trauma team will perform a complete and thorough evaluation in the hospital emergency room. After the vital signs are stabilized, rescue workers will assess obvious bleeding and limb-deforming injuries.īefore moving the patient, the EMS team must immobilize the individual in a cervical (neck) collar and backboard. It may be difficult to assess the extent of their injuries on first evaluation.Īt the accident scene, EMS rescue workers will first check the patient's vital signs, including consciousness, ability to breathe, and heart rate. Patients with fractures of the thoracic and lumbar spine that have been caused by trauma need emergency treatment. These injuries frequently cause serious spinal cord compression. This is an unstable injury involving bone and/or soft tissue in which a vertebra moves off an adjacent vertebra (displacement). It does not usually affect stability.įracture-dislocation. This uncommon fracture results from rotation or extreme sideways (lateral) bending. This type of fracture can occur in a head-on car collision when the upper body is thrown forward while the pelvis is stabilized by a lap seat belt. The vertebra is literally pulled apart (distraction). Extension Fracture Patternįlexion/distraction (Chance) fracture. Some fractures are stable, while others are significantly unstable (the bones have moved out of place). An axial burst fracture can sometimes result in nerve compression. It is often caused by landing on the feet after falling from a significant height. In this type of fracture, the vertebra loses height on both the front and back sides. In these cases, the fractured component is generally resected (coccygectomy).A compression fracture of the lumbar (lower) spine.Īxial burst fracture. Surgery is generally reserved for open injuries requiring soft tissue debridement, or chronic symptomatic injuries. Significant angulation or displacement may require closed reduction, often intra-anal manipulation. best demonstrated on the lateral projection 2Īs a rule, coccygeal fracture/dislocations are treated with non-operative management (e.g.Displacement of the fracture fragment is variable. Most coccygeal fractures have a transverse orientation 2. Within the AO classification system, coccygeal fractures are classified as a subset of the sacrococcygeal fractures (classification A1). In elderly patients, these can represent insufficiency-type fractures 1. Coccygeal fractures in younger adults tend to be after high-energy trauma.
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