High-energy trauma can be arbitrarily divided into:
-
Collision between the patient and the external environment (the vehicle,
or a stationary object if the occupant has been ejected);
-
Acceleration or deceleration forces acting on the patient's internal organs.
Motor vehicle collisions.
- In a frontal collision,
the occupant of a vehicle continues to move forward as the vehicle comes to an abrupt stop.
This forward motion stops when the patient delayed stationary elements of the vehicle interior (seat belts,
seats,
steering wheel,
etc.).
The initial impact point is often the lower extremities,
resulting in fracture/dislocation of the ankles,
knee or hip dislocations and femoral fractures.
As the body continues moving,
the head,
cervical spine and thorax impact on the windscreen and steering wheel.
- In a lateral impact,
the victim is accelerated away from the side of the vehicle.
Compressive pelvic injuries,
pulmonary contusion,
intra-abdominal solid organ injury and diaphragmatic rupture are the most common.
- Rear collisions also accelerate the victim; if head restraints are incorrectly fitted,
the inertia of the head makes the cervical spine vulnerable to injury.
Ejection from a vehicle is associated with a significantly greater incidence of severe or critical injury[6].
- Deceleration/acceleration injuries occur when differential movement occurs between adjacent structures; for example the distal aorta is anchored to the thoracic spine and decelerates much more quickly than the relatively mobile aortic arch.
Shear forces are generated in the aorta by the continuing forward motion of the arch in respect to the distal thoracic aorta.
Similar situations occur at the renal pedicles,
the junction of the cervical with the thoracic spine and also between the white and grey matter within the brain.
The use of a three-point lap-shoulder seat belt reducing risk of death or serious injury for front-seat occupants by approximately 45%[7].
Cyclists
Motorcyclists experience a death rate 35 times greater than the occupants of cars [7]; most of the injuries are to the head and the use of helmets reduces the risk of fatal head injury about one third [9],
and the risk of facial injury by two thirds[8].
Fractures of the lower extremities are also common in motorcyclists,
occurring in approximately 40% of motorcyclists hospitalized for non-fatal injuries[10]. Spinal injuries are also occurs very often in motorcycle MVAs.
Pedestrians
Injuries to pedestrians occur disproportionately among the young (particularly school-aged children),
the elderly and the intoxicated patients [11].
Three impact phases are described during pedestrian injury:
- Bumper impact: in the upright adult,
initial impact is usually on the lower limbs
- Windscreen impact: torso and head injuries occur as the pedestrian impacts the body of the vehicle
- Ground impact: head,
spinal and other collision injuries occur as the displaced pedestrian hits the ground.
Spinal injuries in high-energy trauma.
Acute spinal injuries cause permanent,
frequently profound disabilities and lead to changes in lifestyle ranging from employment to martial status.
They can also greatly diminish quality of life and decrease life expectancy (1).
Early recognition and management of these injuries is essential to minimizing their consequences.
Frequent and the most unfavourable effect spinal trauma is prolonged immobilization.
Potential harmful effects of long immobilization are: airway diseases,
aspiration,
increased intracranial pressure,
cutaneous pressure ulcers,
iatrogenic pain,
increased difficulty of patient handling and treatment costs,
psychic disturbances in intoxicated patients.
MDCT with thin-section reconstruction and multiplanar reformations куму the exact location of fractures and displacement of bone fragments and defines the extent of spinal canal narrowing,
neuroforaminal or vascular compromise.
Spinal fractures classification.
Major and minor fractures.
- A major fracture means that part of the vertebral body,
the pedicles,
or the lamina has fractured.
- A minor fracture means that a part of the posterior (back side) elements of the vertebra has broken—the parts that aren't as vital to spinal stability.
Stable and Unstable Fractures
- Stable fractures don't cause spinal deformity or neurologic (nerve) problems.
- Unstable fractures make it difficult for the spine to carry and distribute weight.
Unstable fractures have a chance of progressing and causing further damage.
They may also cause spinal deformity.
Specific Fracture Types
- Compression fractures is most common in patients with osteoporosis,
or patients whose bones have been weakened by other diseases (such as bone mets). A wedge fracture is a subtype of compression fracture.
With a wedge fracture,
part of the vertebra—usually the anterior (front) part—collapses under pressure and becomes wedge shaped.
- Burst fractures are caused by severe trauma (e.g.,
car accident).
They happen when the vertebra is essentially crushed by extreme forces.
Unlike compression fractures,
it's not just one part of the vertebra that's fractured.
In a burst fracture,
the vertebra is fractured in multiple bony fragments,
whitch can spread out and cause spinal cord injury.
Burst fractures are more severe than compression fractures.
- Flexion-distraction fractures are most frequently occur in car accident, where the body is abruptly pushed forward.
- Frature-dislocation is type of fracture,
then the vertebral body is significantly displaced relative to the other.
C-spine and thoracolumbar fractures.
The most common cause of acute spinal injuries is motor vehicle accidents (MVAs),
accounting for 48% of all injuries.
The next common causes are falls (23%), acts of violence (14%) and sports (9%).
Spinal fractures may follow apparently minor trauma in people with arthritic and osteoporotic disease.
Approximately 10% of unconscious patients who present to the emergency department as the result of a motor vehicle accident or fall have a major injury to the cervical spine.
Most cervical spine fractures occur predominantly at 2 levels.
One third of injuries occur at the level of C2,
and one half of injuries occur at the level of C6 or C7.
Most fatal cervical spine injuries occur in upper cervical levels,
either at craniocervical junction,
C1 or C2.
Although toracolumbar spine fractures more rare than cervical spine fractures,
approximately 40-50% of these injuries are associated with neurologic deficit,
likely because of the tremendous forces needed to fracture this area of the spine (2).
Our experience.
During the three years of working Regional Road Traffic Medical Center in Balakhna,
in Radiology department were examined 208 patients with different spinal injuries resulting from MVAs or another types of high-energy trauma (falls,
etc.).
Of the total number of patients most frequently was men aged 20-35 years (46.4%).