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1. Program-B.P.T-thirdYear
B.P.T –305–PT Orthopaedic
Unit-2
SPINAL FRACTURE
2021-2022/ Lecture no –12 ,13,14 (20/1/22)
DrAnshulGarhpale
Asstprofessor,Physiotherapy /SOMPS

2. X-ray overview
Anatomy overview
Introduction
Causes
Classification
Investigation
Clinical feature
Goals of management
Management/PT management
Cervival-thoracolumbar injury
Rehab
Learningoutcomes
Refrences
<Subject Code>BPT203 <Page No.>1
Outline

3. <Subject Code>BPT203 <Page No.>1
X RAY OVERVIEW

4. Anatomy overview
<Subject Code>BPT203 <Page No.>2

5. Anatomy overview
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-The spine is made of 33 individual bones stacked one on top of the
other. This spinal column provides the main support for your body,
allowing you to stand upright, bend, and twist, while protecting
the spinal cord from injury.
-PARTS :-
1 Spinal cord
The spinal cord has nerve pathways that carry signals, such as pain,
from the arms, legs, and the body to the brain.
2Nerve roots
Nerve roots are used to transmit information between the spinal
cord and the other parts of the body, such as arms, legs and organs.
3Vertebral Body
The cylinder-shaped vertebral body is the weight-bearing structure.

6. Anatomy overview
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4Lamina
The flat plates of the lamina create the outer wall of the vertebral
canal and help protect the spinal cord.
5Vertebral Canal
The spinal cord sits in this channel formed by the lamina and the
vertebral body.
6Pedicles
Pedicles connect the lamina to the vertebral body.
7Discs
Discs separate the vertebrae. They are made of tough, elastic material
that allows the spine to bend and twist naturally.

7. Anatomy overview
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8Articular Facet
The articular facets are where two neighboring vertebrae attach.
9Spinous Process
The spinous process protrudes from the back of each vertebra.
Muscles and ligaments that move and stabilize the vertebrae attach to
the spinous processes.
10Transverse Process
Two transverse processes stick out of the sides of each vertebra.
Muscles and ligaments that move and stabilize the vertebrae attach to
the transverse processes.

8. <Subject Code>BPT203
<Page No.>5
INTRODUCTION
--Spinal fractures are different than a broken arm or leg. A fracture
or dislocation of a vertebra can cause bone fragments to pinch and
damage the spinal nerves or spinal cord. Treatment of spinal
fractures depends on the type of fracture.
.

9. CAUSES
high velocity car accidents, fall from height, or high
impact sports.

10. CLASSIFICATION
There are many different types of spinal fractures:
Compression, Burst, Flexion-distraction, and Fracture-dislocation
1) Compression Fracture:
This type of fracture is very common in patients with osteoporosis,
or patients whose bones have been weakened by other diseases.
2)Burst Fracture:Burst fractures are caused by severe trauma
(eg, 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 places

11. CLASSIFICATION
3)Flexion –Distraction Fracture :-if there's a sudden forward
movement that places incredible stress on the spine, it may break a
vertebra or vertebra
4)Minor fracturemeans a part of the posterior (back side) elements
of the vertebra has broken .
5)Major fracturemeans that part of the vertebral body, the
pedicles, or the lamina has fractured. Fracturing the vertebral body
is considered major because it helps carry so much weight and
distribute the force of your movements.

12. INVESTIGATION/ASSESSMENT
<Subject Code>BPT203 <Page No.7>
-X –rays of spine
Thorough history including MOI and previous spine fractures
Neurological screen
Assessment of patient's pain level and location
Palpation of the thoracic spine
Screen for thoracic fracture
Identification of impairments in ROM, strength, flexibility

13. CLINICAL FEATURE :-
General clinical features:-
Symptoms of a spinal fracture vary depending on the severity
and location of the injury. They include back or neck pain,
numbness, tingling, muscle spasm, weakness, bowel/bladder
changes, and paralysis. Paralysis is a loss of movement in the
arms or legs and may indicate a spinal cord injury. Not all
fractures cause spinal cord injury and rarely is the spinal cord
completely severed.

14. GOAL OF MANAGEMENT
--Reduce pain
--Improve posture
--Improve thoracic mobility
--Strengthen trunk extensors
--Improve trunk control
--Provide education
--Lower extremity strengthening

15. MANAGEMENT
--Treatment of a fracture begins with pain management and stabilization to
prevent further injury. Other body injuries (e.g., to the chest) may be
present and need treatment as well. Depending on the type of fracture and
its stability, bracing and/or surgery may be necessary.
BRACES :-1) maintains spinal alignment
2) immobilizes your spine during healing
3) controls pain by restricting movement.
Stable fractures may only require stabilization with a brace, such as a rigid
collar for cervical fractures, a cervical-thoracic brace (Minerva) for upper
back fractures, or a thoracolumbar-sacral orthosis (TLSO) for lower back
fractures. After 8 to 12 weeks the brace is usually discontinued. Unstable
neck fractures or dislocations may require traction to realign the spine into
its correct position. A halo ring and vest brace may be required.

16. MANAGEMENT
Surgical procedures:-to treat unstable fractures. Fusion is the joining of
two vertebrae with a bone graft held together with hardware such as plates,
rods, hooks, pedicle screws, or cages. The goal of the bone graft is to join
the vertebrae above and below to form one solid piece of bone. It may take
several months or longer to create a solid fusion.
Vertebroplasty&Kyphoplasty:-are minimally invasive procedures
performed to treat compression fractures commonly caused by
osteoporosis and spinal tumors. In vertebroplasty, bone cement is injected
through a hollow needle into the fractured vertebral body. In kyphoplasty,
a balloon is first inserted and inflated to expand the compressed vertebra
before filling the space with bone cement.

17. PT MANAGEMENT
1)Mostthoracic spinefractures occur in the lower thoracic spine, with
60% to 70% of thoraco-lumbar fractures occurring in the T11 to L2
region, which is bio-mechanically weak for stress.

18. CERVICAL ,THORACO-LUMBAR INJURY
1)Fracture of C1 -also known as JEFFERSON FRACTURE. The
patient has neck pain.Spinal cord injury (SCI) is the injury of the
spinal cord from the foramen magnum to the cauda equinawhich
occurs as a result of compulsion, incision or contusion. As a result of
the injury, the functions performed by the spinal cord are interrupted
at the distal level of the injury. SCI causes serious disability among
patients.Thereis a strong relationship between functional status and
whether the injury is complete or not complete, as well as level of the
injury. A complete injury means full loss of motor and sensory
functions at the distal level of injury. Incomplete injury defines
partial preserving of sensory and motor functions below the
neurological level and in the lower sacral segments.

19. CERVICAL INJURY
2) Paraplegia
This term refers to impairment or loss of motor and/or sensory
function in the thoracic, lumbar or sacral (but not cervical)
segments of the spinal cord, secondary to damage of neural
elements within the spinal canal. With paraplegia, arm
functioning is spared but the trunk, legs and pelvic organs may
be involved depending on the level of injury.
1) Tetraplegia (preferred to “quadriplegia”)
This term refers to impairment or loss of motor and/or sensory function
in the cervical segments of the spinal cord due to damage of neural
elements within the spinal canal. Tetraplegia results in impairment of
function in the arms as well as typically in the trunk, legs and pelvic
organs

20. CERVICAL INJURY
1)PHYSIOTHERAPY MANAGEMENT :-
Passive ROM exercises should be done for both upper extremities in C1-C4
level tetraplegia. In injuries of C5 and C6 levels, ROM exercises should be
done to prevent the development of contractures, especially contractures of
elbow flexion and supination
2)Stretching should be done to protect the tenodesiseffect in patients
without active wrist extension and fingers that are not fully stretched.
Muscles are flaccid during the spinal shock period. Exercises can be done
more easily with flaccid muscles. Flaccidity is replaced with spasticity after
the period of spinal shock. Despite the positive effects of spasticity, it has
negative effects on mobility, daily living activities and transferring. The
severity and type of the other complications of SCI affects spasticity and the
precipitating factors should be eliminated for the treatment of spasticity.
Isometric, active or active-assisted truncal exercises should be done in the
patient’s bed if partial movements are present, depending on the injury
level.

21. CERVICAL INJURY
3) Breathing exercises should be carried out and taught and its importance
should be explained to complete or incomplete paraplegic and tetraplegic
patients during the acute phase in order to protect lung capacity.
4)Active and resistance exercisesto strengthen the muscles of the upper
extremity should be initiated at the earliest possible period. Weight and
resistance exercises can be applied with dumbbells in bed depending on the
patient’s muscle strength. Electrical stimulation may be a useful alternative if
extreme fatigue occurs while strengthening the muscles. Shoulder exercises
performed with elastic bandages were found to be effective to reduce
shoulder pain.
5)Decubitus ulcers occur most frequently on the sacrum, ischium, trochanter
and superior aspect of the heel. Flexion contractures of the hip may develop
due to continuous lying on the side and sitting in the wheelchair. Flexor
muscle tension can be reduced with a prone position at regular intervals and
ROM exercises in all directions.

22. CERVICAL INJURY
6) C6 and lower level SCI have the ability to attain 5 motor
skills;
rolling (using momentum) -
mobilizing from supine to long-sitting
unsupported sitting (short-& long sitting)
lifting vertically
Transfers.
7)Aerobic Exercises
Aerobic exercise is another important type of exercise for
patients after spinal cord injury. This type of physiotherapy
gets the heart pumping and boosts circulation.
8) GAIT TRAINING

23. REHABS

24. Learningoutcomes
<Subject Code>BPT203 <Page No.>9
The content helps studentsto identify patientswith spinal fracture, its
assessment, diagnosis and rehabilitation of the patient .

25. References
<Subject Code>BPT203 <Page No.>10
1. B.D Chourasia, anatomy of upperlimb
2.John ebnezer, clinical feature, management.
3.Goel’s physiotherapy
4.Tidy’s Physiotherapy