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Fracture of the spinous process of the spine treatment. Symptoms of a fracture of the spinous process of the cervical vertebra and first aid. Diagnosis and treatment

Occurs most often in the lumbar region. Usually with an indirect mechanism of injury from sudden tension attached to the processes of the quadratus and round large lumbar muscles. Broken processes move downwards and outwards when the muscles are tense.

Diagnostics:

    Pain that intensifies when raising straight legs while lying on your back.

    Sticky heel symptom

    Limitation of spinal movement due to pain

    Radiography

Treatment:

    After general anesthesia with 10 ml of 0.5% novocaine solution, the patient is placed on a bed with a shield on a frog - to relax the lumbar muscles: the hips are separated, the heels are closed, a bolster is placed under the knees.

Exercise therapy, physical therapy, massage. Bed rest – 2-3 weeks.

Fracture of the spinous processes of the vertebrae:

Mechanism: both direct, when hitting the area of ​​the process, and indirect - hyperextension or sharp flexion of the spine.

        Clinic and diagnostics:

        Pain that intensifies when turning the head in the cervical localization, during flexion-extension

        Swelling

        Hematoma

        Crepitation of the fragment

Lateral radiograph

Local anesthesia 1% novocaine solution 3-5 ml per vertebra, immobilization on a hard bed for a period. 10-14 days. For a fracture in the cervical spine, use a cotton-gauze collar for 3-4 weeks.

Damage to the pelvic bones

They make up 4-7% of all fractures and belong to the group of severe injuries. They may be accompanied by the most severe shock caused by irritation of the rich reflexogenic zone and massive bleeding (more than 2 liters) in the tissue of the cancellous bones.

    Classification depending on the participation in the fracture of the pelvic ring and acetabulum: Marginal fracture

    – damage to the pelvic bones that are not involved in the formation of the pelvic ring: fractures of the spines, ischial tuberosities, coccyx, transverse fracture of the sacrum below the sacroiliac joint, fracture of the ilium.– the strength of the pelvic ring decreases, but support is maintained, because both halves of the pelvis are connected to the sacrum, both directly and through the other half: fractures of the same branch of the pubic bone; fractures of the ischial bones; fracture of one of the branches of the pubic bone on one side and the ischium on the other.

    Injuries with disruption of the continuity of the pelvic ring– each half of the pelvis is connected to the sacrum on only one side; vertical sacral fracture or lateral mass fracture of the sacrum;

    rupture of the sacroiliac joint; vertical fracture of the ilium; fracture of both branches of the pubic bone; fracture of the pubic and ischial bones (butterfly type); symphysis rupture

    Damage with simultaneous disruption of the continuity of the anterior and posterior semi-rings of the Malgenya type– the connection between half of the pelvis and the sacrum is completely lost. The damaged half of the pelvis moves upward under the action of muscles

Acetabular fracture

– fracture of the edge of the acetabulum, accompanied by anterosuperior dislocation of the hip; Fracture of the floor of the acetabulum accompanied by central dislocation of the hip

Features of the course and treatment of shock:

In addition to the pain component, there is always significant hemorrhage into the intrapelvic tissue. Shifting the patient or carelessly transporting him can lead to secondary displacement of fragments, increased bleeding and worsening shock.

Treatment: intrapelvic anesthesia according to the Shkolnikov-Selivanov method - injection of 250-300 ml of 0.25% novocaine solution into the iliac fossa, jet transfusion of blood substitutes; local anesthesia with the administration of anesthetic directly to the site of injury.

The lumbar spine experiences stress every day, sometimes strong and sharp, so it is the lower back that is considered the most vulnerable place for damage and the most susceptible to fractures.

Causes of transverse process fractures

As a rule, damage to the transverse process of the vertebra is diagnosed in athletes who practice strength sports. Elderly people are also susceptible to fractures. Often, damage to the lumbar vertebrae can occur as a result of a fall from a height, a work injury, or after an accident. Muscle strain or injury to the lower back in the area of ​​the L1-L4 vertebrae often leads to such fractures.

  1. Types of damage
    1. Complicated with displacement. Broken appendages can move downwards or sideways under the influence of tense spinal muscles. At the same time, they damage surrounding tissues - muscles, blood vessels, nerve endings.
    2. Splintered damage.
    3. Left-handed or right-handed.

Fractures can also be single or multiple. In the second case, the bone processes are affected on both sides.

There is another type of injury - a fracture of the transverse process of the spine is combined with damage to the ribs.

Symptoms

Characteristic symptoms of a fracture of the spinal column are local pain when moving or palpating the back on the injured side of the lower back. Doctors note in patients a symptom of a stuck heel, which manifests itself when a person tries to lift his leg from a supine position. If you do not take any measures to correct the situation, the pain will gradually increase and radiate to the buttock area. In addition, with a complicated displaced fracture, damage to nerve cells occurs, so patients often experience low blood pressure and impaired urination. When examined in a medical institution, traumatologists often note lumbar hematomas and swelling at the site of impact, as well as tension and spasm of the spinal muscle tissue.

How is a fracture determined?

The first thing a traumatologist or surgeon does is listen to the patient’s complaints and clarify whether there have been any injuries or bruises to the lumbar back in recent days. To clarify the diagnosis, the patient may be referred for an X-ray, computed tomography or MRI. Using magnetic resonance imaging, it is possible to study in detail the site of the fracture and assess the condition of the transverse processes. Depending on the severity and type of injury, the doctor may refer the patient for consultation with other specialists, for example, a neurologist or an ophthalmologist.

How is a fracture of the transverse process of the spine treated?

This injury is generally treated conservatively and does not require hospitalization. The main recommendation of the traumatologist, which must be strictly followed, is bed rest. Depending on the condition and severity of the fracture, the patient’s age and other individual characteristics of the patient’s health, bed rest can last from 3 to 5 weeks. The most optimal pose for a speedy recovery is the “frog” pose. To do this, you need to lie on your back, your legs should be bent at the knees, and a high cushion that is comfortable for your back should be placed under them.

In some cases, the traumatologist can fix the lumbar region with a tight bandage or a plaster corset. This treatment does not require bed rest and involves careful physical activity of the person.

To relieve pain, doctors prescribe analgesics, anti-inflammatory drugs or blockades to their patients. Vasodilators and ointments that have a warming effect can also be prescribed. For complex treatment, improving blood circulation and helping the spine, doctors recommend that patients take B vitamins.

In rare cases, when the fragment significantly damages the nerve ending and causes unbearable pain that interferes with normal life activities, surgery may be necessary to possibly remove the severed bone.

Spinal fractures account for 0.5% of all bone fractures. Moreover, the most common injury in this category can be considered a fracture of the transverse process of the vertebra and is most often diagnosed in the lumbar region.

What could be the reason in this case? Most often - a fall from a height, for example, from 3 - 4 floors. The second reason is heavy lifting, but this is mainly detected only when there are other problems with the spine, which leads to a fracture. The third reason is a blow to the lumbar region and injuries received during sports activities, most often while performing gymnastic exercises. And finally, it could be a traffic accident or diving into the water in an unfamiliar place, when there is no accurate data on the state of the bottom.

But a fracture does not only happen as a result of a blow or a fall. In some cases, you can get such damage even if you fall from your own height. It can also appear as a result of another disease, and then it will be considered secondary. Such pathologies include malignant.

Mechanism of damage

The main mechanism of such damage is a direct impact on the spine itself. But this also happens with indirect injury, and here a fracture occurs as a result of a strong contraction of muscle tissue, because the muscles are attached to the transverse processes of the vertebrae.

Most often it is the third lumbar vertebra that is affected. This is explained by the fact that it is the longest and therefore it is the most and most often exposed to trauma.

Fractures can be of several types. The first type is single, that is, in this case only the spine itself suffers and only one damage is noted on it. In the second case, a multiple fracture is diagnosed, in which the bone processes are affected not only on one side, but also on the other. And in the third case, damage to the transverse process is combined with damage to the ribs.

If the fragments are displaced, then the surrounding tissues - muscles, fascia, vessels and nerves - also suffer.

Clinical picture

The main symptom is pain that appears immediately after the injury. It may intensify when the victim tries to tilt his torso in the opposite direction from the site of injury. When you try to lift your leg while lying down, pain also occurs at the site of the lesion. This symptom is called “stuck heel.” The pain also intensifies when trying to bend the leg at the hip joint.

If damage to the nerve roots occurs at the time of injury, this may result in a decrease in blood pressure and difficulty urinating. On examination, hematoma and swelling at the site of impact, as well as tension in the lower back muscles, are noted.

Diagnostics

The first thing to do is listen to the patient’s complaints and collect a life history, and also be sure to find out whether there has been a spinal injury in recent days. Often additional research methods may be required. This could be an X-ray, computed tomography, or nuclear MRI. If necessary, consultation with specialized specialists, for example, an ophthalmologist, a neurologist, or a traumatologist may be required.

Conservative therapy

Fractures of the transverse processes of the lumbar vertebrae are treated mainly conservatively. The main treatment is bed rest, which must be observed for one month, and even longer if prescribed by a doctor. When lying down, the patient should be in the “frog” position. In this case, the legs are bent at the knees and spread apart, and a high cushion is placed under the knees.

To relieve pain, analgesics or blockades are prescribed. UHF therapy helps to cope well with pain. In some cases, vasodilators or ointments and compresses that have a warming effect may be prescribed.

Rehabilitation

After the full course of treatment, the patient must undergo a period of rehabilitation. At this time, it is necessary to engage in physical therapy, attend massage courses, go swimming and undergo a full course of physical therapy. It is also mandatory to wear a belt-bandage on the lumbar region.

The belt-bandage has numerous positive qualities. It helps maintain the lower back in the correct position. The material is breathable, does not irritate the skin and has no seams. You should wear a lower back brace for six months or even a year - it all depends on the nature of the injury and how the healing and rehabilitation period went.

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Isolated spinous process fractures are a fairly rare injury.

Damage most often occurs in the area of ​​the lower cervical and upper thoracic vertebrae; the fracture line runs in the middle of the process.

Causes of fractures

Fractures of the spinous processes occur as a result of direct trauma (impact) and indirect trauma - during sharp flexion or extension, as well as during prolonged overload (digger work). There are fractures of one or more spinous processes.

Symptoms

There is a sudden sharp pain at the level of the broken spinous processes, swelling that smoothes the contours of the process. The victim avoids flexion movements of the torso. On palpation, in addition to pain in the areas of broken spinous processes, one can feel pathological mobility, their deviation from the midline and a change in the distance between them.

Diagnostics

The diagnosis is confirmed by lateral x-rays of the spine.

Treatment of spinous process fractures

Anesthesia with 0.5-1% lidocaine solution. Bed rest for 3-4 weeks. In cases of fractures of the spinous processes in the lumbar and lower thoracic regions, the doctor prescribes wearing a corset. For fractures of the spinous processes of the superior vertebrae, a thoracocranial bandage is used. After the pain goes away, massage, exercise therapy, and physiotherapy are used.

Surgical treatment

Surgical intervention is indicated if the pain syndrome cannot be relieved using conservative treatment methods. The bone fragment of the vertebra is removed.