Nothing happens as often as a bruise. Traumas of this kind accompany us throughout our lives, starting from already preschool age... Children get more bruises than others through their activity. Their body is covered with many abrasions, and this is the first sign of injury. The bruises are painful, take a long time to pass, and the skin near the bruised area acquires a characteristic purple tint.
Proper treatment can heal any bruise, especially minor abrasions. They can be treated without the outside help of a doctor. But if the injury is serious, then it can lead to serious consequences for the body as a whole, which can occur, both immediately after the injury itself, and at the end of the wound healing process. For example: an eye injury can provoke a partial deterioration of vision for a certain period of time, and in special cases, its loss. Head injury, this may be a concussion, but it can lead to negative consequences... In the absence of proper treatment, a person, after a concussion, often develops a headache, blood circulation is disturbed by the vessels of the brain, and the pressure in the skull rises.
Whiplash neck injury
The atlas is articulated anteriorly with the lairs through a synovial articulation reinforced by the transverse ligament. Atlas also pivotally connects to the axis through paired synovial faceted joints, which have capsules that contribute to their stability. It is the unique anatomy of these vertebrae that allows their associated movement in rotation, flexion and lateral bending, protecting the spinal cord, paired vertebral arteries and cranial nerves when they cross the area. The subaxial cervical spine has consistent anatomical features between its levels up to the cervicotorosac junction, where the transition from a relatively mobile segment to a rigid one occurs.
Actions in the presence of bruises should be as follows
The first step is to examine the injury and understand its origin. If the bruise is strong enough and is accompanied by a sharp pain in the area of impact, you should call a specialist who will provide qualified medical care. You should not fight this kind of injuries on your own, you can only harm. In addition, home conditions cannot guarantee normal treatment and recovery from bruises, as a result, they can be dangerous to health.
The vertebral body bears two-thirds of the vertebral load. Posterior bone elements include the lamina, edges, and spinous processes. They provide attachment to capsule-fiber structures, which include supraspin and interpin ligaments, flagum ligaments, and facet capsules. These structures contribute to stability by providing resistance to tensile forces and are commonly described as creating a trailing back band. The facet joints provide primary containment of the anterior subluxation.
Upper cervical vertebrae injuries
The anatomical features of each segment of cervical movement predispose levels to different patterns of injury and, as a result, require individual assessment. Oxypitocervical dissociation is an uncommon injury that is difficult to identify and is associated with high mortality. The most common mechanism of injury is a pedestrian hit by a car, with a high incidence of pediatric patients. This is calculated as the ratio of the distance from the base to the rear arch of C1 to the distance from the front arch of C1 to the opistory.
The main characteristic of a bruise is the presence of hemorrhages in the subcutaneous areas, that is, hematomas.
Often, pain when hitting an object is the result of not only structural damage to the skin, but also subcutaneous tissue - muscles, periosteum, bones.
Let's look at some of the types of injuries that happen in everyday life and try to figure out what actions should be taken to treat these injuries.
A more reliable method for assessing the presence of craniovertebral dislocation is Harris's rule 12. Harris described the line drawn by the cephalal from the posterior body C2. An increase in this distance indicates instability. The classification of these injuries is based on occiput displacement. Another option is to perform rigid fixation using a plate or screw rod design. Various systems are now available that allow rod atta on the occipital plates, with reports of their usefulness.
The advantage of these methods is that immobilization in a rigid cervical collar is all that is required. A method of fixation from the occiput to the lateral mass of the atlas has been described, but is awaiting further evaluation. It has been reported to occur in 3-15% of trauma patients. - The most commonly used classification system for these injuries is the one proposed by Anderson and Montesano. This injury is not considered unstable. It is also a permanent injury given that the alar ligaments and tectorial membrane are intact.
Bruised hand
Nothing is more prone to injury than hands. Often, after receiving a bruise, swelling may appear on the hands. They reduce the ability to work. And if such edema is improperly treated, then you can get a disability for life.Hand bruise treatment
Cold can stop inflammation after injury and relieve pain, so the first thing to do after injury is to put on a cold compress. It can be made at home. It is necessary to wrap a few pieces of ice in a cloth. At severe pain, which does not go away for a certain time, but only increases, you need to visit a traumatologist. He will determine the nature of the injury, excluding a bone fracture or a crack in it. Before going to the doctor, the hand must be tightly wrapped with a bandage, motionlessly attached to the body, using a scarf tightened around the neck. Also, the bandage will help reduce pain in the sore arm, reduce the rate of edema and tissue inflammation.Today, in medical equipment stores and pharmacies, you can find many special fixation bandages for different parts of the body, especially for the hands. They are aesthetically pleasing and securely fix the hand in a fixed position. They also help you heal faster.
If an associated disruption of the alar ligaments and tectorial membrane occurs, then there is the potential for instability. Fractures in the Atlas are common fractures cervical spine, accounting for 10% of all fractures of the cervical spine. They have a high frequency of association with other fractures of the cervical spine. Posterior arch fractures are usually bilateral, the most common and stable. Fractures of the transverse mass are usually unilateral and may be unstable if there is an associated ligamentous injury.
You can start treating a sore arm two days after the injury, applying warming compresses and applying ointment to accelerate tissue repair.
Traditional medicine contains a sufficient number of recipes for ointments and medicinal mixtures. For example, you can use the following recipe to treat bruises in your hand - mix horseradish juice with an alcohol solution and spread this mixture on the area that hurts. You can use another method - to insist 30 grams of horsetail in 0.5 liters of boiling water for 30 minutes. Apply a compress soaked in such a tincture to the injured area. Another method is popular among the masses: to attach slices of raw potatoes to the sore spot, fixing them with gauze. From funds traditional medicine allocate: diclofenac gel, ibuprofen, ketoprofen and others. For increase therapeutic effect, these ointments should be applied 4 times a day.
The rupture is commonly referred to as a Jefferson fracture and has a characteristic fracture pattern in both the anterior and posterior arches. For non-overlapping or minimally displaced fractures, only a cervical brace is required for 8-10 weeks. For explosive cracks with instability or significant displacement, various treatments have been used. Traditional treatment- bed rest with traction for 4-6 weeks to reduce lateral mass displacement, followed by the use of a halo vest for mobilization.
Atlantic Rotational Instability
This technique theoretically damages the atlantoaxial joints in young patients, although widespread applicability has not yet been confirmed. Atlantoxial rotational instability is an uncommon trauma in adult patients. It is usually the result of traumatic injury and is often associated with other fractures of the cervical spine. Most of the descriptions and assessment methods are the result of case reports in the non-traditional pediatric population; and as a result, the applicability is limited in the trauma adult patient.
Knee injury
Bruises knee joints more often athletes and active adolescents who often go in for sports are ill. These injuries are characterized by severe edema. Within a few hours after injury, the knee swells, pain intensifies. The pain also causes a decrease in the ability to walk with the leg that has received a bruise.Knee contusion treatment
First of all, the knee should be immobilized and not subjected to pressure, that is, not to walk. For this, the patient is placed on a horizontal surface, and the diseased leg is slightly raised, substituting something under it. Immediately after injury, ice should be applied to the leg (wrap it in a cloth to prevent frostbite).From funds traditional medicine you can use an alcoholic tincture from bog flowers. This tincture should be applied to the injured area, twice a day, rubbing lightly.
Mechanism of injury
Normal constraints on excessive atlantoaxial instability are provided by alar and cross-linking. These injuries are often overlooked in the initial assessment and are delayed with pain, shards, and limited head rotation. Treatment is aimed at reducing cravings. If it is stable after contraction, then the application of the halo is considered the standard of care. If the injury appears to be unstable or late presentation, the options are open reduction and subsequent stabilization versus stabilization in place.
One more good remedy- fresh wormwood. It is quite simple to prepare it: grind the grass in a mortar to a state of gruel or pass it through a meat grinder. No more unnecessary actions. Apply this gruel to the joint, covering it with a bandage on top, squeezing strongly.
If the injury is serious, it is necessary to see a doctor, physical and x-ray examinations. And if you need to get rid of pain, then you can use voltaren, analgin, indomethacin, diclofenac, ibuprofen, naproxen or ketoprofen.
Complex treatment of injuries of the cervical spine
The method is at the discretion of the surgeon, although individual patient factors, surgical risk, and the surgeon's individual experience will determine the choice. The instability of Atlanto-Densa is the result of a rift transverse ligament and sometimes the ligaments of the alar and tectorial membrane. This is usually the result of a flexion injury. It is assessed by measuring the anterior atlanto-dense interval. In adult patients, up to 3 mm is considered normal. Treatment is aimed at stabilization. Immobilization of the halo does not provide reliable treatment, given the low healing potential of these injuries.
Bruised toe
Injuries to the toes are the second most common after injuries to the hands. Most often, people get injured toes during seasons when their feet are not protected by clothing or shoes. Usually this is the summer period and the time for gardening. Also, perhaps, training time in the halls. Most are convinced that a toe injury does not pose a particular threat, it is minor and should heal quickly. But this is not the case.Toes, this is the congestion zone a large number tendons. The disappearance of pain after a finger injury is not a sign that it has fully recovered. It often happens that tendons and soft tissues grow together incorrectly, which, over time, make themselves felt. Uncomfortable shoes also serve as a pain return factor that will occur even in sleep. If the bruise does not heal for a long time, then this can lead to the development of a disease such as arthritis.
For this reason, it is recommended that individuals with significant instability undergo C1-2 fusion using one of the above methods. Odontoid fractures are common fractures of the cervical spine, accounting for up to 20% of all cervical spine fractures in some studies. They have a bimodal incidence, with the first peak in young patients associated with high energy trauma; and a second peak occurring in older patients in combination with low energy mechanisms such as falls.
These injuries usually have no neurological involvement, although a spectrum of injuries can be seen, ranging from mild weakness upper limb until complete quadriparesis. The line of destruction is located at the junction of the odontoid base and body. The prediction and rate of consolidation are closely related to both the type of fracture and the level of displacement. For this reason, more aggressive initial treatments have been advocated in favor of individual patients. In the eligible patient, odontoid screw fixation is the treatment of choice for these common fractures and has supplanted halo immobilization.
Treatments for a bruised toe
Cold is one of the first "remedies" to be used for this kind of injury. You need to swipe an ice cube over your finger for 4 hours for 15 minutes every hour. After pain relief, you can repeat the procedure, but with an interval of two hours. Warming compresses are best left on the next day. They are not allowed to be used at the time of injury. Doctors recommend starting to use warm compresses 2-3 days after getting a bruise.Don't forget about your nails. If the injury has caused damage to the nail, then it must be fixed with a medical plaster.
All of these are reported to have high pooling ratios, although biomechanical advantages exist for the latter two approaches. - Disadvantages include morbidity of posterior surgical procedure in an elderly patient and loss of rotation. Given the many possible surgical approaches, the surgeon's familiarity and comfort with each of them will determine the optimal treatment in each case, although their use in the author's "practices" is reserved for irregular tooth fractures in symptomatic patients.
Traumatic spondylolisthesis of the axis
Fracture fracture is a term that is often used to describe traumatic axial spondylolisthesis, although the relevance of the term, which hears the era of prosecutions, has been questioned. This fracture is usually the result of high energy trauma and its most common mechanism is hyperextension and axial loading, which is commonly associated with motor vehicle accidents. They are rarely associated with neurological deficits. The classification has four primary types with one further addition - "atypical" pattern.
It is better for the patient to stay in bed without loading the foot and not putting stress on the toe itself. There is no need to wrap and bandage your finger, let it "breathe". Wear only comfortable shoes that will not cause discomfort to your feet.
There are several recipes in traditional medicine that can help treat a bruised toe.
Horseradish is a great help. It is necessary to rub it on a fine grater and apply the resulting mass on the sore finger. Besides horseradish, you can use sugar and onions. Chop a few onions and cover with powdered sugar. Allow time for some juice to come out. Apply the mixture on a piece of cloth and, with massaging movements, rub over the area of the finger. Modern medicine recommends the use of gels containing dimexide or heparin, such as "Lyoton". They can help relieve pain and speed up recovery. Traumeel can be another remedy.
As a result, cravings are contraindicated to decrease. The latter type was described more recently by Starr and Eismont and is considered an "atypical" fracture pattern in which the fracture propagates through the posterior C2 organ rather than the vapor. Another alternative to a long-term delivery is immediate operational stabilization after a contraction has been achieved. This can be accomplished using a variety of methods. One of the methods is direct osteosynthesis of the fracture using transpedicular screws. The disadvantage of this approach is that it does not address potential disk space instability.
Head bruise
From light blows to the head, so-called "bumps" appear - small swellings that disappear over time. But if the "bump" does not disappear, and symptoms such as loss of consciousness, nausea are added to the headache, then this suggests that the injury is not so easy as it seemed at first glance. These symptoms are very dangerous because they directly indicate that the bruise caused a concussion.Treatment of head bruises
In case of severe injuries, calling a doctor is mandatory and immediate. With mild degrees, when only a "bump" occurs, cold compresses will come in handy. The main thing to remember is that the ice should be wrapped in a cloth. And also, you need to follow the rules for using the compress - do not keep it in one place for more than 15 minutes.In case of head injuries, the victim must be provided with rest and bed rest. Constantly monitor the state of his body.
Subaximal injury of the cervical spine
The final method is to screw the hind leg C2 into place using the C3 side screws. Prospective comparisons of clinical outcomes have yet to be performed, but retrospective case series indicate relative clinical equivalence between different methods stabilization for unstable fractures that require open repair and stabilization using one of the above methods. Subaxial cervical spine injuries represent a wide range of injuries and degrees of instability.
From traditional medicine, you can use a comfrey-based ointment, but only in the case when a concussion is not recorded. And from pharmacy medicines, Dolobene gel, heparin-based ointment, Troxevasin or Traumeel ointment are quite suitable. If the doctor gives a verdict in the form of a concussion, then it is better to put the patient in a hospital and let the doctors do their job.
The current grading systems that are most commonly used are mechanistic classifications, which, while useful for categorizing trauma patterns, do not reliably predict stability and management. For this reason, the discussion of specific injuries will consider the potential for instability and management approaches for each overall picture of injury.
Compression damage
Compression damage is one of the main classification groups proposed by Ferguson and Allen, and represents a continuum of injuries, with minor degrees of trauma, leading to fractures of compression fractures of a simple vertebra and more severe injuries, which leads to a fissure crack "lacrimal" or quadrangular fracture with subsequent ligamentous destruction. It was noted that the frequency of injury spinal cord in Allen and Ferguson's compressive flexion series ranges from one in the mildest injury pattern to 91% in the most severe.
Bruised neck
A very dangerous type of body injury, which can lead to both damage to the soft tissues of the neck and displacement of the cervical vertebrae. Such injuries can be accompanied by impaired blood flow to the brain area. And this, as a result, can lead to a lack of nutrients and oxygen in the brain. The cells of the cerebral cortex will suffer, which will cause irreversible actions. Coordination of movements may be impaired, the mobility of the arms and legs may decrease, and paralysis of some parts of the body is quite possible.Treatment for a bruised neck
For mild trauma, apply something cold - an ice medical compress. This should be done for other injuries to the body as well. The patient needs to provide peace and quiet.If the injury occurred somewhere in nature and there are plantain leaves nearby, then use them. Just knead the leaf in your hands and apply it to the site of the injury. The Nanoplast Forte plaster will help you recover faster and relieve pain
If pain persists and new symptoms develop, you should see a doctor. Only a qualified doctor with special medical devices and equipment is able to maximally assess the severity of the injury and prescribe the correct treatment. If the patient wishes, it is possible to resort to acupuncture and physiotherapy exercises, but this is only after consultation with the doctor.
Back injury
This is one of the most dangerous injuries to the human body, as it is directly related to the spinal injury. And they don't joke with this. A spinal injury can result in lifelong disability. If a back injury occurs, the patient should be put to bed, ensured peace of mind and call a traumatologist.Back injury treatment
With mild forms of back injury, you can use the folk method - take a bath with mint infusion. The proportions are as follows - in one bucket of water, brew 100 grams of dried mint. A common white bean ointment may also help. It needs to be cooked, passed through a meat grinder until a thick mass is formed and applied to the sore spot, covering it with a bandage on top. From the means of traditional medicine, you can apply "Voltaren emulgel".Bruise in the chest area
Chest contusions can often cause cardiovascular and respiratory trauma. The consequences can be cardiac arrhythmia, dyspnea, disruption of the respiratory organs, pain in the chest area, rupture of the lungs. During severe injuries, painful shock may occur.Help with chest bruises
A very positive effect can be produced by parsley gruel, which must be mixed with vinegar in a 1: 1 ratio. Or use a 1: 1 mixture of honey and vinegar. A bandage with such a mixture must be applied to the sore spot and changed periodically to ensure a constant supply of fresh substances. It is allowed to use such dressings until the bruises disappear. It helps very well in the treatment, the infusion of the arnica plant, which can be taken both internally and by applying a cloth bandage.Bruised eye
Dark spots under the eyes are the first sign of a bruised eye. In addition, trauma can be accompanied by severe pain and swelling, and decreased visual acuity.Treatment of eye bruises
An eye injury cannot be treated at home; if you suspect a serious injury, you should consult an ophthalmologist. The standard set recommended by the ophthalmologist is thiamine ointment, antibacterial drops, chloramphenicol.Eye trauma requires strict care. Initially, this concerns the application of a clean, sterile eye patch. You can make lotions from infusion of blue basil: 2 teaspoons of basil per 200 ml of boiling water, let it brew for several hours. Such lotions will help disinfect the area around the eye and reduce the risk of exacerbation. inflammatory processes... Alternatively, you can use bird cherry blossom tea.
Always treat your body wisely, do not forget to visit your doctor if necessary. Treat with folk methods only after the permission of your doctor.
Reviews on this article: 1
Elena, 05/20/2014
A rather simple recipe helped me - a compress with burdock. Rinse the burdock leaf and bottom side rub with laundry soap, wrap the foot with this side. Put on a cotton sock, a plastic bag, a woolen sock. Make this compress at night, by the morning you will feel a significant improvement.
In adults, injuries to the cervical spine occur at all levels. They are most often caused by a fall or motorcycle injury, in which direct exposure to the head results in flexion, extension, lateral displacement, or rotation of the cervical spine.
Injuries of the cervical spine at the level of the first vertebra
Dislocations in the atlanto-occipital junction are caused by overstretching, overextension, or transmission influences. The main stabilizer of the atlanto-occipital junction is the integumentary membrane ruptured by trauma. Depending on the direction of displacement of the I vertebra in relation to the occipital bone, anterior and posterior dislocation is distinguished. Anterior dislocations are most common. Associated injuries may include injuries to the chin, tears in the back of the throat, and fractures. lower jaw... Damage to the cranial nerves, rupture of the vertebral artery, and damage to the first three cervical spinal roots are quite often observed and usually lead to the death of the patient.
With fractures of the first vertebra, fractures of the condyles of the occipital bone can also occur. They are due to compression or lateral displacement. In this case, a fracture of the condyle or a detachment of the pterygoid ligament occurs. Often, with fractures of the occipital condyles, paralysis of the cranial nerves occurs.
Fractures I cervical vertebra arise due to the combined effect on the atlas of both axial load and flexion or extension efforts. There are fractures of the anterior and posterior arch of the Atlas, as well as combined fractures of the anterior and posterior arches (explosive fractures or Jefferson's fractures). And although atlas fractures are usually not accompanied by nerve damage, 50% of them are associated with fractures of other cervical vertebrae. Most often, there is a combination of a fracture of the odontoid process of the axial vertebra and the posterior arch. Fractures of the transverse processes and inferior cusp of CI are avulsion.
Injuries of the cervical spine at the level of the second vertebra
Traumatic CI-CII instability is rare, but can be associated with damage caused by excessive flexion. A rupture of the transverse ligament leads to subluxation at the CI-CII level. Normally, the gap between the atlas and the tooth is less than 3 mm. If this gap is 3-5 mm, then there is a rupture of the transverse ligament. If the gap between the atlas and the tooth exceeds 5 mm, then this also indicates a rupture of the pterygoid ligament. Although dislocation is usually fatal, a full spectrum of neurological disorders can also be observed. Rotational subluxation and dislocation in the atlantoaxial joint occurs when flexion or extension with rotation is combined. In this case, torticollis usually occurs in the neck, and neurological disorders are rare. CII fractures may involve damage to the odontoid process, vertebral body, lateral masses, or isthmus. Fractures of the odontoid process are the result of flexion, extension, or rotational stress. According to the classification of Anderson and Alonso, there are three types of these fractures. Type 1 (the rarest) is characterized by a tooth detachment. The most common type 2 fracture is characterized by a fracture of the base of the tooth at the level of its junction with the CII body, and the degree of displacement is considered high if the diastasis between the fragments is 5 mm or they are displaced at an angle of 11 degrees. In type 3, the plane of the fracture passes through the body of the CII. Fractures of the articular surfaces of CII are compressive and rarely accompanied by neurological disorders. Fractures of the CII isthmus, or so-called "executioner" fractures, lead to traumatic spondylolisthesis of the axial vertebra. These fractures occur under the influence of flexion or extension loads, as well as under the influence of axial loads, or are the result of overextension and stretching. They often occur in car accidents, falling or hanging. They are accompanied by fractures of other cervical vertebrae, ruptures of the CI-CII intervertebral discs, one or bilateral dislocations of CI-CII, as well as damage to the vertebral arteries and cranial nerves. In the absence of dislocation, spinal cord injuries are rare.
Injuries of the cervical spine at the level of the third vertebra and below
Fractures CIII-CVII are more often the result of blunt trauma, car accidents, diving and falls. According to the classification of Allen and Ferguson, these fractures are grouped according to the mechanism of their occurrence. Most often they are referred to as compression and flexion.
Compression-flexion injuries of the cervical spine, located below the II cervical vertebra, lead to a progressive inability of the posterior spine to withstand stretching, and the anterior spine - compression. These injuries are the result of vertebral end plate fractures and lead to complete dislocation and fragmentation of the vertebral bodies, as well as to weakness of the posterior ligamentous apparatus. As a result of vertical compression injuries, ruptures of the end plates of the vertebral bodies occur. Less severe injuries are not accompanied by significant displacement of the vertebrae. However, with more significant impacts, bone fragments can move towards the spinal canal and damage the spinal cord. Most often, these lesions are noted at the CVI-CVII level.
Subaxial trauma to the cervical spine due to stretching occurs under the action of flexion or extension. Simultaneous stretching and flexion damages the posterior ligamentous apparatus. As a result, one- and two-sided dislocations are possible, subluxations - with a vertical displacement of the articular surfaces. With a progressive displacement of the body of the upper vertebra anteriorly, narrowing of the spinal canal and damage to the spinal cord are possible. Spinal cord injuries occur when the diameter of the spinal canal decreases to 13 mm or less (in the sagittal plane). Stretching and simultaneous extension lead to damage to the anterior ligamentous apparatus or fractures of the anterior part of the vertebral bodies, which causes the anterior intervertebral space to expand. As the changes progress, damage to the posterior ligamentous apparatus occurs, which leads to a posterior displacement of the body of the overlying vertebra.
Subaxial lateral flexion injuries of the cervical spine are caused by unilateral asymmetric application of force from the head. In this case, on the side of the impact, damage to the vertebral arch occurs, and on the opposite side, damage to the ligaments. On the side of the damaged ligaments, displacement of both the arch of the vertebra and its articular surfaces is possible.
Avulsion fractures of the spinous processes (the so-called duck fractures) are flexion and occur at the level of the CII-TI vertebrae. Most often, the fracture occurs at level CVII, but CVI and TI are also often affected.
Diagnostics of the injury of the cervical spine
Spinal injuries should be suspected following a fall, car accident, or other serious injury. The first health care must be provided at the scene. It consists in immobilizing the spine and transporting the victim to a trauma hospital. If necessary, appropriate resuscitation measures and intensive therapy should be carried out to maintain the basic vital functions of the victim. These activities are described in the guidelines of the American Surgical Association.
History and objective research. After carrying out the necessary intensive therapy and stabilizing the patient's condition, a detailed history should be collected and an objective study should be carried out. In the presence of injuries to the face, head, neck and abdomen, the likelihood of concomitant spinal injury increases. Examination of the spine includes palpation, which can reveal local soreness, asymmetry, or pathological mobility of the spinous processes. A thorough neurological examination of the patient should be performed, including examination of sensitivity, motor functions and reflexes. To assess the severity of spinal shock, the tone of the sphincter of the anus and sensitivity in the perianal region should be examined. Preservation during the initial examination of the bulbous-membranous (bulbous-cavernous) reflex indicates the absence of spinal shock and that the neurological symptoms are caused by damage to the spinal cord. The absence of this reflex indicates the presence of spinal shock. Restoration of the bulbous-membranous reflex, usually observed after 24-48 hours, indicates that the spinal shock has resolved and the neurological deficit is due to structural changes in the spinal cord.
Spinal cord injuries can be accompanied by total or partial neurological deficits. Total neurological deficit is characterized by a lack of sensitivity and motor activity below the level of damage. In partial neurological deficits below the injury site, individual spinal functions are preserved.
There are four types of partial neurological deficits.
- The most common central injury to the spinal cord leads to paralysis of the arms and legs, as well as dysfunction of the intestines and bladder. The restoration of functions is more pronounced in the area of the lower extremities in comparison with the upper ones.
- Anterior spinal syndrome is characterized by the preservation of deep sensitivity and proprioception, but loss of motor activity and superficial sensitivity. The motor function is practically not restored.
- Posterior spinal syndrome is characterized by preservation of motor function and sensitivity, but loss of proprioception, deep baro- and pain sensitivity.
- Brown-Séquard syndrome is a unilateral injury to the spinal cord, leading to a loss of motor activity on the opposite side, as well as a loss of cutaneous temperature sensitivity.
Figurative research methods... In the department emergency care it is necessary to perform an X-ray in case of injury of the cervical spine with the inclusion of the level CVII-TI. After stabilization of the patient's condition, it is necessary to perform a complete X-ray examination of the cervical spine, including X-ray in the anterolateral projection, as well as a projection that allows you to assess the condition of the tooth of the axial vertebra. By examining radiographs, bones and soft tissues should be assessed for abnormalities, as well as the correct location of the vertebrae. Normally, in adults, the distance from the base (the lowest point of the anterior edge of the foramen magnum) to the tooth is 4 mm. An increase in distance indicates a dislocation of the atlanto-occipital joint. With an increase in the distance between the atlas and the tooth, revealed in the study of the X-ray of the lateral projection of the cervical spine, one should suspect instability at the level of the CI-CII vertebrae. Rotational subluxation at the CI-CII level should be suspected with asymmetry of the articular surfaces of the axial vertebra, revealed on a chest x-ray taken through the open mouth.
To identify and assess the nature of soft tissue and spinal cord lesions, MRI and CT can also be used for trauma to the cervical spine. Some patients are not able to report on the neurological symptoms that appear during reduction of cervical vertebrae dislocations. Therefore, before reduction, an MRI scan should be performed if the cervical spine is injured. Latent fractures of the cervical spine are best detected by CT examination.
Treatment of cervical spine injury
CI and CII injuries of the cervical vertebrae... Dislocations of the atlanto-occipital junction can be treated either by immobilization or by fusion of the occipital bone and CII. Excessive distraction should be avoided when using loop traction. In case of stable fractures of the occipital condyles, immobilization in the Shants collar is used, in case of their instability - immobilization in the Halo head fixator. Explosive fractures of CI, as well as fractures of its anterior arch, are usually treated by immobilization in a Halo head fixator; in cases of chronic instability and pain, CI-CII osteosynthesis is indicated. CI posterior arch fractures are usually stable and can be treated with orthopedic immobilization. Traumatic instability CI-CII often serves as an indication for posterior osteosynthesis. In case of dislocation or rotational subluxation of CI-CII, reduction by traction with subsequent osteosynthesis or immobilization in the Halo head fixator is indicated.
Treatment of CII fractures is determined not only by the type of fracture, but also by the presence of concomitant dislocation or deformity. In case of tooth fractures of the 1st type, immobilization with an orthopedic apparatus is indicated. For type 2 fractures that are not accompanied by dislocation, and for type 3 fractures, immobilization in the Halo head fixator for 12 weeks is indicated. If, at the same time, a displacement of more than 5 mm remains between CI and CII, or there is an angular displacement or non-union, then posterior osteosynthesis is indicated. For fractures of the CII isthmus, not accompanied by dislocation, immobilization in the Halo head fixator is indicated. In the presence of dislocation and fractures with displacement at an angle, reduction with subsequent immobilization in the Halo head fixator is indicated. If there is a progressive neurological deficit and the formation of a herniated disc, then anterior decompression and osteosynthesis CII-CIII are indicated. With pronounced angular displacement and dislocation, posterior osteosynthesis CI-CII is indicated.
Damage CIII-CVII... In flexion compression subaxial injuries that are not accompanied by injuries of the middle and posterior columns, the cervical spine remains stable; therefore, immobilization in the Halo head fixator for 8-12 weeks is indicated. However, if the middle and back posts are damaged, it may be necessary to prevent delayed deformity in order to prevent delayed deformity. surgical treatment. Surgery consists in anterior corporectomy with corporodesis (fixation of the bodies of adjacent vertebrae). In case of instability and posterior displacement of fragments, posterior fusion may also be required.
For vertical compression subaxial injuries of the cervical spine and the absence of neurological deficits, immobilization with a Halo head fixator is usually indicated. If there is a neurological deficit, then anterior decompression with fusion is indicated.
In case of distraction subaxial injuries of the cervical spine, treatment tactics depend on the nature of the injury - flexion or extensor. Distraction flexion injuries are unstable and often accompanied by disc herniation. Treatment consists of precise reduction and posterior fusion. MRI should be performed before reduction in the presence of partial neurological deficit and one or two-sided dislocation. In the presence of a distraction extensor injury and an intact posterior longitudinal ligament, immobilization with a Halo head fixator will be an adequate method of treatment. If there is damage to the posterior longitudinal ligament, then anterior decompression with cervical plate fusion is indicated.