Residual stability of the craniovertebral segment in its various injuries

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Abstract

Residual stability of craniovertebral segment in the most common injuries (odontoid process fractures, ring fractures of C2, Atlas fractures, etc.) was sudied in experiment. The study was performed in 7 cadaveral craniovertebral blocks. The range of movement before and after injuires modelling, the estimation of force that caused the vertebrae displacement using special loading test device were detected. It was shown that in any injury without vertebrae dislocation craniovertebral segment possessed the residual stability. The minor stability was noted in odontoid prosess fractures of II and III types and «butcher’s»fractures, the major stability was in the intervertebral disc injuries of C2-C3 and occipital condyle fractures. On the base of experimental and clinical data the conclusion was done that fixation of cervical spine using head support with frontal fixative or halo apparatus were indicated for cranivertebral segement injuries without vertebrae dislocation. In dislocation of vertebrae it was necessary to reduce the dislocation and open surgical intervention for stabilization.

About the authors

S. T. Vetrila

Central Institute of Traumatology and Orthopedics. N.N. Priorov

Author for correspondence.
Email: info@eco-vector.com
Russian Federation, Moscow

S. V. Kolesov

Central Institute of Traumatology and Orthopedics. N.N. Priorov

Email: info@eco-vector.com
Russian Federation, Moscow

N. S. Gavryushenko

Central Institute of Traumatology and Orthopedics. N.N. Priorov

Email: info@eco-vector.com
Russian Federation, Moscow

References

Supplementary files

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2. Fig. 1. Craniovertebral block in a stress test machine.

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3. Rice. Fig. 2. The results of the load test. On the abscissa axis - the displacement of the vertebrae (in mm), along the ordinate axis - the magnitude of the effort (in N). (fiol) — fracture of the odontoid process type 2; (red) - fracture of the odontoid process type 3; (burgundy) - a typical fracture of the "executioner"; (ser) - atypical fracture of the "executioner"; (yellow)—Jefferson's fracture; (green) - fracture of the occipital condyle; (blue) - disc rupture C2-C3.

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4. Fig. 3. Fracture of the odontoid process of C2 vertebra type 2 before (a) and after (b) stress test.

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5. Fig. 4. Fracture "executioner" typical before (a) and after (b) stress test.

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6. Fig. 5. Jefferson fracture before (a) and after (b) stress test. On the radiograph in the lateral projection after the load, the expansion of the gap of the Cruvelier joint is visible.

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7. Fig. 6. Range of motion in the craniovertebral block before injury (□), after damage modeling (□), and after a load test using force that caused the maximum displacement of the vertebrae. 1 - fracture of the odontoid process type 2; 2 - fracture of the odontoid process type 3; 3 - a typical fracture of the "executioner"; 4 - atypical fracture of the "executioner"; 5 - Jefferson's fracture; 6 - damage to the disk C2 ~ C3; 7 - fracture of the occipital condyle.

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