FRAKTUR VERTEBRA

Pembimbing :
dr. Erwien Isparnadi, Sp.OT
Penyusun:
Tristy Yuniar P
Tomy Wijaya k
Yudha prakasa

SMF BEDAH RSU HAJI SURABAYA

FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH MALANG
2016

BAB I
PENDAHULUAN
Columna vertebra berfungsi melinungi
medulla spinalis.
Fraktur dapat terjadi pada semua
bagian, termasuk vertebra.
Fraktur
pada
vertebra
dapat
menyebabkan kerusakan pada spinal
nerves atau spinal cord.

BAB 2
TINJAUAN PUSTAKA
Anatomi Vertebra
Vertebra terbagi atas
beberapa bagian :

7 Tulang vertebra servikalis

12 tulang vertebra thorakalis
5 tulang vertebra lumbalis
5 tulang vertebra sakralis
4 tulang vertebra koksigeal

2013-11-12

Otot leher ekstensi kepala dan

terletak
relatif
dalam:
m.
Semispinalis
capitis
dan
m.longissimus capits

Otot leher ekstensi kepala dan

terletak relatif dalam: m. Splenius
capits

Classification of
Fractures of c-spine
HYPERFLEXION INJURIES
Flexion teardrop fracture
Hyper flexion Strain
Clay-shovelers fracture
Hyper extention injuries
Hangman fracture
Extention teardrop
fracture

FRACTURE DUE TO AXIAL

LOADING
Jefferson fracture
Burst fracture
OTHER INJURIES
Odontoid fracture
Rotational Injuries

Hyperflexion
Distraction creates
tensile forces in
posterior column
Can result in
compression of
body (anterior
column)
Most commonly
results from MVC
and falls

Compression
Result from axial
loading
Commonly from
diving, football,
MVA
Injury pattern
depends on initial
head position
May create burst,
wedge or
compression fxs

Hyperextension
Impaction of posterior
arches and facet
compression causing
many types of fxs

lamina
spinous processes
pedicles
With distraction get
disruption of ALL
Evaluate carefully for
stability
LOOK FOR CENTRAL
CORD SYNDROME

Types of Injuries

TRAUMA CERVIKAL
FRAKTUR AVULSI :
(fraktur clay shoveller).

 Flexion Teardrop Fracture

fracture is the result of a combination of flexion and compression

,most commonly at C5-6
The teardrop fragment comes from the anteroinferior aspect of the
vertebral body. The larger posterior part of the vertebral body is
displaced backward into the spinal canal.
Best seen on lateral view It is an completely unstable fracture
associated with complete disruption of ligaments and anterior cord
syndrome and quadriplegia 70% of patients have neurologic
deficit. common in MOTOR VECHICLE ACCIDENT

2013-11-12

11

Extention tear drop fracture

AVULSION FRACTURE of
anterio inferior content of
the axis resulting from
hyperextention
This injury is stable in
flexion but highly unstable in
extension.
common in diving accidents
It also may be associated
with
the
central
cord
syndrome .

STRAIN SERVIKAL
(WHIPLASH)
The term whiplash given on a soft tissue injury that
occurs when the neck arrived - arrived snapped into
hyperekstenstion. usualy these injuries occurred
after a hit from behind ; body was thrown forward
and head jerked back .

Whiplash injury
Akibat strain atau sprain
pada segmen servikal
Strain: cedera pada otot

Sprain: cedera pada

ligamen

Etiologi
Kecelakaan lalu lintas

Gambaran klinis
Nyeri kronis ~ sendi
zigoapofisial & kapsul faset
Nyeri tekan
Lingkup
gerak
sendi
berkurang
2013-11-12

Sakit kepala (oksipital)

Penglihatan kabur/dobel
Disfagia
Suara serak ~ hematoma
retrofaringeal
Nyeri rahang
Gangguan
keseimbangan, vertigo

Pemeriksaan Fisik
Lordosis
servikal
menurun ~ spasme otot
Nyeri tekan

16

 The Quebec Taskforce on Whiplash-Associated

Disorders has suggested the following system for
classifying the severity of cervical sprains:
0 : No neck pain complaints, no physical signs
1 : Neck pain complaints, only stiffness or tenderness, no
other physical signs
2 : Neck complaints and musculoskeletal signs (decreased
range of motion [ROM] and point tenderness)
3 : Neck complaints and neurologic signs (weakness,
sensory and reflex changes)
4: Neck complaints with fracture and/or dislocation

2013-11-12

17

FRAKTUR C1
(FRAKTUR JEFERSON)

Fracture is caused by a
compressive
downward
force that is transmitted
evenly through the occipital
condyles to the superior
articular surfaces of the
lateral masses of C1.
This process displaces the
masses laterally and causes
fractures of the anterior and
posterior arches, along with
possible disruption of the
transverse ligament.

Hangmans Fracture C-2

Fx through the pars
interarticularis of C2
secondary to
hyperextension
Best seen on lateral
view
Hyperextention injury
Stable fracture ?

Classification of Hangman' s
fractures

Type I (65%)
hair-line fracture
C2-3 disc normal
Type II (28%)
displaced C2
disrupted C2-3 disc
ligamentous rupture with
instability
C3 anterosuperior compression
fracture
Type III (7%)
displaced C2
C2-3 Bilateral interfacet
dislocation
Severe instability

FRAKTUR ODONTOID
Odontoid
fractures
caused by accidents
due to driving in high
speed or falling hard.
Fractures that this shift
is actually a fracture dislocation of the joints
atlantoaksial where the
atlas slides forward or
backward , as well as
bringing
with
him
odontoid processes .

Classification
Type I: Avulsion of the tip
of the dens where it is
attached
to
C1.
This is a rare fracture.
It is potentially stable.?
Type II: Through the base
of
the
dens.
Most common fracture.
Always unstable and poor
healing.
Type III: Fracture through
the body of the axis and
sometimes
facets.
Can be unstable, but has a
better prognosis than type
II due to better healing of
the fracture which runs
through the metaphyseal
body
of
C-2

Jenis-jenis imobilisasi

Soft collar

Hard collar

Cervical orthrosis

Cervical orthrosis

Halo orthrosis

Cervico-thoracics

Fraktur Thorakal
Thoracic vertebral fractures are usually
caused by trauma to the longitudinal
axis of the vertical through. Bone Injury
occurs because of the burden falling
over or falling from a height

The cause of fractures :

Trauma vertically along the longitudinal axis of
the spine due to trauma of the head or from
below . In these circumstances occur such as in
trauma fracture fractured cervical vertebrae .
hyperflexion trauma fracture with collapse of
one or more two vertebrae in a wedge-shaped
front and that will give kyphosis
Flexion accompanied by rotation will result in a
fracture and dislocation of the intervertebral
joints where there is a shift in the upper vertebra
to vertebra below it

Injury Thorakolumbal
The most common cause of injury was
a fall from a height torakalumbal and
accidents. In an accident with On crash
with high speed and great power often
obtained assorted combinations of
styles that flexion , rotation and
extension so that the type of fracture is
invoice dislocation

There are two types based on stability ,

namely :
stable injury
unstable injury

 Prosessus transverse fracture

Usually occurs after a direct trauma or
crushed by heavy objects . Fractures can be
on only one prosessus tranversus or more on
the same side . Fractures can be
accompanied by such a tool in kidney damage

Compression Fractures
Compression on the front of the vertebral
corpus depressed and form a wedge fracture .
Compression fractures are the most common
fractures affecting the vertebral column

Fracture
crushed
( Burst fractures )
Fractures occur when there is
an emphasis vertebral corpus
and bone directly into the bone
distruption. Terminologi this
fracture is spreading towards
the edge of the vast corpus
vertebralis caused more severe
accidents than compression
fractures.

Fraktur dislokasi
Occurs when there is a segment
of the vertebrae move from its
place
because
of
the
compression
,
rotation
or
pressure. Damaged so very
unstable, this injury is very
dangerous.
Therapy depending on whether
there is cord or nerve roots are
damaged. Damaged will occur in
the third part of the vertebral
Culomna with a combination of
mechanisms accident occurred,
compression, pressure, rotation
and peeling process.

Cedera pisau lipat (seat belt fracture)

Diagnosis
Anamnesa
Physical examination
Inspection support

Management
First aid and emergency treatment of
spinal trauma consists of : assessment
of consciousness , airway , breathing ,
circulation
Therapy on vertebral fracture begins to
overcome pain and stabilization to
prevent further damage again , it all
depends on the type of fracture

 Braces & Orthotics . There are three

things that do that :
1.Mempertahankan vertebral alignment
(alignment )
2.Imobilisasi vertebrae convalescing .
3.Overcome the pain that is felt by
limiting pergerakan.Fraktur that are
stable in need of stabilization

 This technique is a surgical technique

used for unstable fractures . Fusion is
the process of merging the two
vertebrae with bone graft assisted with
platrods tools , hooks and pedicle bone
graft is screws

 vertebroplasty & Kyphoplasty . This

action is a procedure that minimal.
invasion principle of this technique is
used in compression fractures caused
by osteoporosis and vertebral tumors

Fracture lumbal-classification of
columna spinalis

FRACTURE LUMBAL
Classification
Fracture minor : fraktur pada bagian belakang
vertebra yang tidak vital untuk stabilitas spinal.
Termasuk di dalamnya fraktur processus
spinosus dan facet joint
Fracture mayor : fraktur yang mengenai corpus
vertebra, pedikel, atau lamina. Fraktur corpus
vertebra dianggap mayor karena berfungsi untuk
menyangga beban tubuh. Fraktur pada pedikel
atau lamina dianggap berbahaya karena dapat
terjadi kerusakan saraf.

Based on the stability of the spine :

Fractures stable: if not cause spinal
deformity or neurological problems .
Vertebrae are still able to function
almost like normal
Fractures instabil : difficulty vertebrae
to support the load of the body and can
continue to further damage . There
deformity .

Based on the type of fracture

Fraktur kompresi : often occur in patient
with osteoporosis or patients with low
density bone.
Burst fracture : due to high energy
resulting an fracture comunitif
Flexion-distraction fracture : when body
force to the anterior. It result flexion of
vertebra
Fracture-dislocation : there is a fracture
and a dislocation in vertebra.

MECHANISM OF INJURY

Trauma Fleksi

Hiperekstensi atau
retrofleksi

fleksi dan rotasi

kompresi
vertikal

Burst fracture

FRACTURE SACRUM
Definition : fracture of the sacrum is
the complete or incomplete fracture in
the sacrum

KLASIFIKASI DENIS fracture

sacrum

Transverse sacral fracture is rare , usually

only 5 % of the fractures that occur
sakral.Karena fracture is transverse , then
classified in 3 Denis fracture , but the
fracture line usually includes three zones
called the transverse tersebut.Fraktur H , U
, lambda and T- shaped fracture

KLASIFIKASI ROY- CAMILLE

Roy- Camille et al . And
Strange - Vognsen and
Lebech
Denis
zone
3
classification split into 4
subclassification:
Fracture type 1 shows the
kyphosis angulation of the
fracture.
Fracture type 2 shows the
kyphosis and partial anterior
translation .
Fracture type 3 shows the
kyphosis with a complete
translation .
Fracture type 4 shows the
segmental fraction of S1 with
axial compression

KLASIFIKASI ISLER
Isler I do not interfere with the
stability of the lumbosacral, but it
can affect the stability of the
pelvic ring.
Fractures of the lumbosacral
junction were out past the L5 - S1
facet classified as type II.
Fractures of the lumbosacral
junction coming out of the medial
facet III.
Fraktur classified as type III type
usually associated with instability
of the lumbosacral junction.Injury
type III shows the separation
sacrum
bilaterally
with
lumbosacral section

Fracture Coccyx
Etio:
Mostly occurs when landing in the seated
position, but also during childbirth

Diagnosis:
tenderness palpated rectally or eksternaly
over coccyx

Management
Conservative :
Analgesic
Stool softener-docusate (Dulcolax)
Bed rest, Donut ring cushion

Discharge with orthopedi

Surgical exission of fragment for chronic
pain

Fiksasi Leher

Empat Orang Penolong

Dua Orang Penolong