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Spinal fracture

Definition and Epidemiology

  • Spinal fractures refer to breaks or dislocations in the vertebrae, the bones that make up the spinal column.
  • Can occur from trauma (e.g., car accidents, falls, sports injuries) or pathologically due to osteoporosis, tumors, or infection.
  • Higher risk in individuals with osteoporosis, certain sports activities, and in those involved in high-impact trauma.

Types of Spinal Fractures

  • Compression Fracture: Vertebrae collapse, common in osteoporosis.
  • Burst Fracture: Vertebrae shattered, potentially sending bone fragments into the spinal canal.
  • Flexion-Distraction (Chance) Fracture: Vertebrae pulled apart, often due to seatbelt injury in car accidents.
  • Fracture-Dislocation: Bone fracture with dislocation, leading to instability of the spine.

Pathophysiology

  • The mechanism of injury determines the type of fracture.
  • High-energy trauma can cause more severe injuries, potentially affecting the spinal cord.
  • Pathological fractures result from weakened bone structure due to underlying conditions.

Clinical Features

  • Pain at the site of the fracture; can be severe.
  • Neurological symptoms if the spinal cord or nerves are involved: numbness, weakness, paralysis.
  • Limited mobility and deformity depending on the severity of the fracture.

Diagnosis

  • Clinical assessment and detailed trauma history.
  • Imaging: X-rays for initial assessment, CT for detailed evaluation, MRI if spinal cord injury is suspected.
  • Neurological examination to assess for cord or nerve root injury.

Management

  • Stabilization of the spine and patient is the first step.
  • Pain management and immobilization.
  • Surgical intervention may be necessary for unstable fractures, fractures with neurological involvement, or significant deformity.
  • Conservative treatment (bracing, rest) for stable fractures without neurological involvement.
  • Rehabilitation for recovery and prevention of complications.

Complications

  • Spinal cord injury, leading to paralysis or sensory loss.
  • Chronic pain.
  • Post-traumatic deformity of the spine.
  • Secondary complications due to immobility.

Prognosis

  • Depends on the type of fracture, presence of spinal cord injury, and overall health of the patient.
  • Stable fractures without neurological involvement generally have a good prognosis.
  • Severe fractures with spinal cord involvement have a more guarded prognosis.

Prevention

  • Preventing high-risk activities that lead to trauma.
  • Management of osteoporosis and other conditions that weaken the bones.
  • Use of protective gear in high-risk sports and activities.

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