FRACTURE OF SPINE
The spine (vertebral column) is made up of a number of small bones called a vertebrae arranged one above another. The spine is supported by many strong ligaments and the muscles of the trunk. It protects the spinal cord contained within it. The spinal cord is delicate and if damaged, loss of sensation or power can occur in parts of the body below the injured area, e.g. upper limbs, lower limbs. Permanent damage will result if the cord is partially or completely transected.
Fractures of the vertebrae can be caused by both direct and indirect force. Neck and lower back are two areas in spinal column most vulnerable to injuries. If there is a violent forward bending, a backward bending, or a twisting injury of the spine, it is likely to get fractured. Causes of spinal injury are as follows.
1. Awkward fall in gymnastics.
2. Diving into a shallow pool.
3. Fall from a height.
4. Fall from a horse or a motor cycle.
5. Fall of a heavy object on the back e.g. roof-fall.
6. Head-on crash of a motor vehicle.
7. Trauma to the head or face.
8. Whiplash injury.
9. Jarring of spine by a fall on the feet, buttocks or head from a height.
The condition is diagnosed by the following features.
1. Severe pain in back.
2. Irregularity may be felt over the spine.
3. Tenderness on gently feeling the spine.
Features of injury to the spinal cord.
• Loss of sensation of skin below the level of injury.
• Loss of control over limbs.
• Abnormal sensations : tingling or burning, limbs feel heavy, stiff, or clumsy.
• Difficulty in breathing.
First-aid
1. Do not move the victim. Support his head in neutral position.
2. Instruct the victim not to move.
3. In case of suspicion of neck injury, place rolled blankets or other articles around the neck and shoulders to steady the neck and prevent its movement.
4. Shift him to a hospital immediately. Transport on a rigid stretcher with face upwards. The canvas stretcher must be made hard surfaced by short boards placed across the stretcher or a long board itself may be used if a stretcher is not available. Place small pillows under the neck and the small of the back so that the hollow of neck and the back rest in the normal position. The position of the casualty must not be disturbed when loading on to the stretcher. One person must hold the head firmly but gently. Another person must hold the legs just above the ankles so as not to disturb the trunk.
□ FRACTURE OF PELVIS
Fracture of the pelvis is mostly due to a direct force, e.g. crush accidents, fall of beams. The impact of a car dashboard on a knee can force out the head of the thigh bone through the hip socket. If may also be due to an indirect force, e.g. fall from a great height on the feet. These may be complicated by injury to internal organs, particularly the urinary bladder and urinary passage which the pelvis protects. Internal hemorrhage may be severe enough to cause shock.
The condition is diagnosed by the following features.
1. Pain and tenderness in the region of the hip, groin, and/or back, aggravated by movements.
2. Inability to walk or even stand, although the legs appear normal.
3. Difficulty in passing urine.
4. Blood in urine.
5. Signs of internal bleeding and shock.
First-aid
1. Place the victim on the back with legs straight. The knees may be bent a little and a rolled blanket may be placed underneath them if the victim finds that more comfortable.
2. Treat shock, if present.
3. Ask him not to attempt to pass urine.
4. Immobilize his legs by bandaging them together, placing padding between the bony points. But if that causes severe pain, untie them.
5. Shift him to a hospital on a stretcher in the most comfortable position.