Abstract
Fractures of the vertebral column are particularly important regarding neurological complications. Pathomechanism of the forces causing these fractures are important due to their role
from the point of the type of fractures, their treatment and complications. There are 5 mechanisms causing vertebral body fractures
A — When vertical compression force is loaded upon vertebra,
cartilaginous plate is fractured first and then cancelleous body
is crushed. If the forces go on to be increased the body is explosed.
There İractures are seen mostiy between T9 -L3.
B — Normally, flexion axis of the intervertebral joints of
lumbar vertebrae passes thru nuclevus pulposus. If the vertebra
is forced to hyperilexion around this axis the anterior part of
vertebral body, in front of the axis the anterior part of vertebral
body, in front of the axis is loaded, with a force 4 times greater
than the posterior part and the front part ol the vertebra body
crushes. While lateral force is added, lateral wedge fracture
OCCUİS.
C — Although posterior ligamentous complex ruptures by
pure flexion force, it can rupture due to flexion - rotation or stressed rotation. It the degree of flexion is great, pure dislocation
may occur. Under these forces, upper vertebra slides over the
lower one and carries the disc along and slice fracture of the
upper rim of the lower vertebral body occurs. These fractures
usually are unstable.
D — When patient's pelvis is fixed to his seat with seat belt,
his body is flexed due to flexion force and then traction forces
act upon posterior elements and vertebra fractures with 45 degree
angle in regard to the compression line. There fore vertebral body
and posterior elements are horizontalIy splitted.
E — Forced hyperextention ruptures anterior longitudinal
ligament. But, this could not be Shown experimentaliy. Cervical
vertebrae are more often İractures than the other parts of the column. If rotation force is added, ligaments easily rupture. In this type of İracture, posterior part of vertebral body, lamina and
pedicles fracture,
References
- 1 — Apley, G. A.: A System of Orthopaedics and Fractures. 2. ed. pp. 327-329, 1963. Butterworths, London.
- 2 — Brown, T., Hansen, R. J., and Yorra, A. J.: Some Mechanical Tests in the Lumbosacral Spine with Particular Reference to the Intervertebral Discs. J. Bone and Joint Surg., 39 - A : 135, 1953.
- 3 — Bick, E. M.: Management of Fractures of the Vertebrae in the Elderly. Am. J. Surg., 87 : 764, 1954.
- 4 — Böhler, L.: The Treatment of Fractures Volume I. pp. 300-319, 1956. Grune and Stratton, New York and London.
- 5 — Calve, J. and Galland, M.: Revue d'Orthopédie. se. Serie 17 : 5, 1930.
- 6 — Connell, E. H. and Reynolds, C. F.: Key and Conwell's Management of Fractures, Dislocations and Sprains 7th. Ed. pp. 365, 1961. The C. V. Mosby Co. St. Louis.
- 7 — Dietrich, H. F. R. G. and Steward, S. F.: Tetanus and Lesions of Spine in Childhood. J. Bone and Joint Surg., 22 : 143, 1940.
- 8 — Epstein, B. S.: The Spine. A Radiological Text and Atlas. 2. Ed. pp. 405 - 409, 1962. Lea and Febiger, Philadelphia.
- 9 — Holdsworth, W. F.: Fractures and Dislocations of the Lower Thoracic and Lumbar Spines with and without Neurological Involvement. Current Practice in Orthopaedic Surgery. Vol. 2. pp. 61, 1964. Editor: John P. Adams. The C. V. Mosby Co. St. Louis.
- 10 — Holdsworth, W. F.: Fractures, Dislocations and Fracture - Dislocation of the Spine. J. Bone and Joint Surg., 45 - B : 6 - 20, 1963.
- 11 — Howorth, B. M.: Fracture of the Spine. The American Acad. of Orthopaedic Surgeons. Instructional Course Lectures Vol. XIV. pp. 64 - 90, 1957.
- 12 — Howorth, B. M. and Petri, G. S.: Injuries of the Spine. pp. 244 - 249, 1964. The Williams and Wilkins Co. Baltimore.
- 13 — Isarlt, H. J.: Roentgen Evaluation of Fractures Resulting from Convulsive Shock Therapy. Am. J. Roentgenol., 68 : 247 - 254, 1952.
- 14 — Nickel, V. L.: Injury to the Spine. Early Management of Acute Trauma. Editor: Nahum M. A., pp. 88 - 105. The C. V. Mosby Co. St. Louis, 1966.
- 15 — Nicoll, E. A.: Fractures of the Dorsolumbar Spine. J. Bone and Joint Surg., 31 - B : 376 - 394, 1949.
- 16 — Orren, D. B.: Fractures of the Dorsal and Lumbar Spine. Clinical Orthopaedics and Related research., 49 : 195 - 200, 1966.
- 17 — Rands, C. W.: Posttetanic Gibbus. Bull. Los Angeles Neurol. Soc., 3 : 141, 1938. 18 — Rennie, W. and Mitchell, N.;: Flexion - Distractlon Fractures of the 'Thoraco - Lumber Spine. J. Bone and Joint Surg., 55-A :386, 1973.
- 19 — Roaf, A.: A Study of the mechanlcs of Spinal injurlies. J. Bone and Joint Surg., 42-B:810 -823, 1960.
- 20 — Smith, 8. W. and Kaufer, H.: Patterns and Mechanisms of Lumber Injurles Associated with Lap Seat Belts, J. Bone and Joint Surg., 51-4; 239 - 264, 1969,
- 21 — Watson - Jones, S. R.: Fractures and Joint Injuries. Vol. 2 pp. 946 - 983, 1955. Williams, Baltimore,
- 22 — Weltzmann, G.: Treatment of Stable Thoraco-lumber Spine, Compresslon Fractures by Harly Ambulation. Clinical Orthopaedics and Related research, 76 : 116, 1971.
- 23 — Wiles, P.: Fractures, Dislocations and Sprains, pp. 38-39, 1. ed., 1960. J. and A. Churchill Ltd. London,
Abstract
Vertebra kırıkları özellikle nörolojik komplikasyon nedeniyle
önem taşırlar. Bu kırıklara yol açan kuvvetlerin tesir mekanizmaları gerek kırık tipleri gerekse de bunların komplikasyon ve tedavileri bakımından önem taşırlar. Vertebra cisim kırıkları beş
mekanizma ile olmaktadır :
A — Vertebre vertikal kompresyona maruz kaldığı zaman
önce vertebra kıkırdak plağı kırılmakta sonra spongiöz korpus
kısmı kırılmaktadır. Kuvvet daha fazla devam edecek olursa korpusta eksplozyon yapmaktadır. Bu tip kırıklar en çok T9 - L3 arasında olmaktadır.
B — Normalde lomber intervertebral mafsalların fleksiyon
aksı nucleus pulposus'tan geçer. Bu aksın etrafında hiperfleksiyoha zorlanma ile bu aksın ön kısmındaki cisme arka kısıma nazaran 4 misli daha fazlak uvvet biner ve vertebra cisminin ön kısmında ezilme olur. Buna lateral kuvvet eklenirse lateralde kamalanma, olur.
C — Saf fleksiyonla posterior ligament kompleksi seyrek ola- rak yırtıldığı halde fleksiyon - rotasyona veya zorlu rotasyona ma- ruz kalması halinde rüptüre olur. Fleksiyon miktarı kuvvetli ise saf dislokasyona kadar gidebilir. Bu kuvvetlerin etkisi altında üst- teki vertebra alttakinin üzerinde kayar ve diski de beraberinde taşır. Alt vertebra cisminin üst kenarının kama şeklinde bir dilim gibi kısmını da beraberinde taşır. Bu kırıklar genellikle stabil de- ildirler.
D — Fleksiyon - distraksiyon mekanizması ile hastanın pelvi- si koltuğa tesbit edilmiş vaziyette iken kuvvetin tesiri ile öne tlek- siyona gelir. Sonra başlıca etki posterior elementlerde olarak trak- siyon sonucu kompresyon hattına 45 derecelik bir açı altında kı- rık hattı oluşur ve horizontal olarak vertebra cismi ve posterior elementler ayrılmış olur.
E — Zorlu hiperekstansiyonla anterior longitudinal ligament rüptüre olur. Fakat bunu deneysel olarak göstermek mümkün olmamıştır. Servikal vertebralarda daha sık olarak rastlanmaktadır. Rotasyon kuvvetinin eklenmesi ile ligament rüptürü kolaylaşmaktadır. Vertebranın posterior kısmı, lamina ve pediküller kırılır.
References
- 1 — Apley, G. A.: A System of Orthopaedics and Fractures. 2. ed. pp. 327-329, 1963. Butterworths, London.
- 2 — Brown, T., Hansen, R. J., and Yorra, A. J.: Some Mechanical Tests in the Lumbosacral Spine with Particular Reference to the Intervertebral Discs. J. Bone and Joint Surg., 39 - A : 135, 1953.
- 3 — Bick, E. M.: Management of Fractures of the Vertebrae in the Elderly. Am. J. Surg., 87 : 764, 1954.
- 4 — Böhler, L.: The Treatment of Fractures Volume I. pp. 300-319, 1956. Grune and Stratton, New York and London.
- 5 — Calve, J. and Galland, M.: Revue d'Orthopédie. se. Serie 17 : 5, 1930.
- 6 — Connell, E. H. and Reynolds, C. F.: Key and Conwell's Management of Fractures, Dislocations and Sprains 7th. Ed. pp. 365, 1961. The C. V. Mosby Co. St. Louis.
- 7 — Dietrich, H. F. R. G. and Steward, S. F.: Tetanus and Lesions of Spine in Childhood. J. Bone and Joint Surg., 22 : 143, 1940.
- 8 — Epstein, B. S.: The Spine. A Radiological Text and Atlas. 2. Ed. pp. 405 - 409, 1962. Lea and Febiger, Philadelphia.
- 9 — Holdsworth, W. F.: Fractures and Dislocations of the Lower Thoracic and Lumbar Spines with and without Neurological Involvement. Current Practice in Orthopaedic Surgery. Vol. 2. pp. 61, 1964. Editor: John P. Adams. The C. V. Mosby Co. St. Louis.
- 10 — Holdsworth, W. F.: Fractures, Dislocations and Fracture - Dislocation of the Spine. J. Bone and Joint Surg., 45 - B : 6 - 20, 1963.
- 11 — Howorth, B. M.: Fracture of the Spine. The American Acad. of Orthopaedic Surgeons. Instructional Course Lectures Vol. XIV. pp. 64 - 90, 1957.
- 12 — Howorth, B. M. and Petri, G. S.: Injuries of the Spine. pp. 244 - 249, 1964. The Williams and Wilkins Co. Baltimore.
- 13 — Isarlt, H. J.: Roentgen Evaluation of Fractures Resulting from Convulsive Shock Therapy. Am. J. Roentgenol., 68 : 247 - 254, 1952.
- 14 — Nickel, V. L.: Injury to the Spine. Early Management of Acute Trauma. Editor: Nahum M. A., pp. 88 - 105. The C. V. Mosby Co. St. Louis, 1966.
- 15 — Nicoll, E. A.: Fractures of the Dorsolumbar Spine. J. Bone and Joint Surg., 31 - B : 376 - 394, 1949.
- 16 — Orren, D. B.: Fractures of the Dorsal and Lumbar Spine. Clinical Orthopaedics and Related research., 49 : 195 - 200, 1966.
- 17 — Rands, C. W.: Posttetanic Gibbus. Bull. Los Angeles Neurol. Soc., 3 : 141, 1938. 18 — Rennie, W. and Mitchell, N.;: Flexion - Distractlon Fractures of the 'Thoraco - Lumber Spine. J. Bone and Joint Surg., 55-A :386, 1973.
- 19 — Roaf, A.: A Study of the mechanlcs of Spinal injurlies. J. Bone and Joint Surg., 42-B:810 -823, 1960.
- 20 — Smith, 8. W. and Kaufer, H.: Patterns and Mechanisms of Lumber Injurles Associated with Lap Seat Belts, J. Bone and Joint Surg., 51-4; 239 - 264, 1969,
- 21 — Watson - Jones, S. R.: Fractures and Joint Injuries. Vol. 2 pp. 946 - 983, 1955. Williams, Baltimore,
- 22 — Weltzmann, G.: Treatment of Stable Thoraco-lumber Spine, Compresslon Fractures by Harly Ambulation. Clinical Orthopaedics and Related research, 76 : 116, 1971.
- 23 — Wiles, P.: Fractures, Dislocations and Sprains, pp. 38-39, 1. ed., 1960. J. and A. Churchill Ltd. London,
Details
| Primary Language | English |
|---|---|
| Subjects | Orthopaedics |
| Journal Section | Articles |
| Authors | |
| Publication Date | June 30, 1975 |
| Published in Issue | Year 1975 Volume: 28 Issue: 1-2 |