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Clinicals

Break suddenly


•• A 27 Year old man is brought in 25 minutes after a motor vehicle accident. He was the front seat passenger and wore a seat belt during that time. Now he complains of excruciating lower back pain,Described as 10/10 on visual analog scale. The primary survey shows no threats to his airway, Breathing and circulation. His GCS was 15/15 ,and both pupils are equal and reactive. As a part of further investigations we proceeded with X-ray which was not evident with any fractures of cervical spine and chest.

ON YOUR EXAMINATION VIEW :

Secondary survey :  Point tenderness over The L4 Vertebra No other musculoskeletal findings

CNS : No focal neurological signs

Heart, Lungs and abdomen :No abnormalitie

Perform relevant investigations

Break suddenly


Select relevant management options

Break suddenly


  • Venous Thromboembolism prophylaxis
  • Opioid analgesia
  • Thoracolumbosacral orthosis
  • L4 Vertebroplasty

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Break suddenly


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Break suddenly


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Explaination

Break suddenly


•• Here we could see the man has presented with excruciating lower back pain following a motor vehicle accident in which he was restrained front seat passenger. As similar to any other trauma cases ,We are supposed to proceed with Advanced trauma Life support guidelines.

Here the primary survey,  and FAST Scan were not evident with life threatening injuries. However, Secondary survey is evident with tenderness Over the L4 vertebra,Without focal neurological evidence.

Now, Possibility of the vertebral injury mandates the CT of the spine. This confirmed us the presence of compression fracture  that appears to be stable.

When we look at the morphology and stability of the fracture and lack of neurological deficits ,We don't indicate the MRI imaging here. Neither there exist justification for the skeletal survey.

Considering the MANAGEMENT PART, conservative management is sufficient here, this includes the immobilisation and strict bed rest. We Avoid the Vertebroplasty and other Surgical procedures right now.As per some studies use of orthoses don't improve outcomes in these patients.

Further, When we consider the severity of his pain, Opioid analgesia is Advisable. We may convert to NSAID later on. Given the necessity of the immobilisation,   venous Thromboembolism prophylaxis should be considered.

REFERENCE : CHANG VICTOR ,HOLLY LANGSTON, :Bracing of Thoracolumbar fractures.

•• ELNOANAMY HOSSAM : Percutaneous Vertebroplasty,A first line treatment in Traumatic non -Osteoporotic Vertebral compression fracture.

•• MCgrith Mathew Wong :Vertebral compression fracture, review on current management and Multimodal therapy.

•• Rajashekaran S ,Kanna Rishimugesh ,Shetty Ajoyprasad ,Management of thoracolumbar spine trauma an overreview.