FRACTURES

Part 2

SYMPTOMS OF FRACTURE5

• A fracture of the thoracic or lumbar spine causes moderate to severe back pain that is worsened with movement.

• If the spinal cord or nerves are affected during the fracture, the patient may experience bowel/bladder dysfunction along with numbness, tingling, or weakness in the arms or legs.

• If the fracture is caused by high-energy trauma, the patient may also have a brain injury and lose consciousness, or “pass out.” If the patient is reported to have lost consciousness during the injury or is still unconscious, spine injury is often assumed. There may also be other injuries that are more painful than the pain caused by fractures of the spine. In these cases, it has to be assumed that the patient has a fracture of the spine, especially after a high-energy event such as a motor vehicle collision.

Emergency Stabilization

Patients with fractures of the thoracic and lumbar spine that have been caused by trauma need emergency evaluation and treatment. However, it may be difficult to assess the extent of their injuries on first evaluation.

At the accident scene:

• EMS rescue workers will first check the patient’s vital signs, including consciousness, ability to breathe, and heart rate.

• After the vital signs are stabilized, rescue workers will assess obvious bleeding and limb-deforming injuries.

• Before moving the patient, the EMS team will immobilize the individual in a cervical (neck) collar and backboard.

The patient is then transported to the hospital for more detailed exams in the emergency room.

Physical Examination

• The emergency room doctor will conduct a thorough evaluation, beginning with a head-to-toe physical examination of the patient. This will include an inspection of the head, chest, abdomen, pelvis, limbs, and spine. The doctor will evaluate the patient’s neurological status. This includes testing:

* The patient’s ability to move, feel, and sense the position of all the limbs.

* The patient’s reflexes, to help determine whether there has been an injury to the spinal cord or individual nerves.

 • The doctor may also check the tone of the anal muscles and determine whether the patient is able to empty their bladder without assistance. Problems with bowel and bladder function may indicate a more serious spinal cord injury.

Tests

Imaging tests. After the physical examination, a radiologic evaluation is required.

Depending on the extent of injuries, this may include X-rays, computerized tomography

(CT) scans, and magnetic resonance imaging (MRI) scans of multiple areas, including the thoracic and lumbar spine.

Treatment

Treatment for a fracture of the thoracic or lumbar spine will depend on:

• Other injuries and their treatment

• The fracture pattern

• Whether there is neurological injury

 Once the trauma team has stabilized all other life-threatening injuries, the doctor will evaluate the spinal fracture pattern and decide whether spine surgery is needed.