OR2.7-8 | Axial Skeleton Injuries — Glossary

Interventional radiology technique using coils or gelfoam to occlude actively bleeding arterial vessels identified on CT angiogram; targets the ~10-15% arterial component of pelvic haemorrhage.

Injury to the anterior two-thirds of the cord (anterior spinal artery territory); bilateral loss of motor function and pain/temperature sensation below the level with preserved proprioception and vibration; worst prognosis among incomplete syndromes.

Pelvic fracture pattern from a front-to-back force producing symphysis diastasis and progressive SI joint opening; APC-III with complete disruption carries the highest haemorrhage risk.

Standard classification of SCI completeness from A (complete — no S4-S5 function) to E (normal); based on systematic examination of 10 key muscle groups and dermatomal sensation bilaterally.

A medical emergency in SCI above T6; a noxious sublesional stimulus triggers uncontrolled sympathetic discharge (severe hypertension, bradycardia, headache, sweating above the level); treat by eliminating the stimulus and sitting the patient upright.

Hemisection of the spinal cord producing ipsilateral motor weakness and loss of proprioception plus contralateral loss of pain and temperature; best prognosis among incomplete SCI syndromes.

Anal sphincter contraction in response to penile or clitoral squeeze (or catheter tug); its return marks the end of spinal shock, after which the ASIA grade can be considered definitive.

Vertebral body fracture from axial loading in which the nucleus pulposus explodes through the endplate, shattering the vertebral body circumferentially and often retropulsing fragments into the spinal canal.

Compression of the lumbosacral nerve roots below L1-L2; produces lower motor neuron features — flaccid paralysis, saddle anaesthesia (S3-S5 perianal/perineal region), urinary retention, faecal incontinence; surgical emergency.

The most common incomplete SCI; hyperextension in a spondylotic cervical spine causes disproportionate upper > lower limb weakness, bladder dysfunction, and variable sensory loss; best functional recovery of arm/hand function.

Flexion-distraction spinal fracture where a horizontal shear force (seatbelt injury) divides the spine through the posterior and middle columns; associated with intra-abdominal organ injury in 30% of cases.

Philosophy of rapid provisional fracture stabilisation to control haemorrhage and pain, followed by delayed definitive fixation once physiological parameters (temperature, pH, coagulation) are restored.

Classification of sacral fractures by relationship to the sacral foramina: Zone I (lateral to foramina, lowest neurological risk), Zone II (through foramina, L5/S1 root risk), Zone III (central canal, bladder/bowel/sexual function risk).

Bedside ultrasound examination detecting free fluid in the pericardium and four peritoneal windows; negative FAST does NOT exclude retroperitoneal (pelvic) haemorrhage.

Bilateral traumatic pedicle fractures of C2 from hyperextension-distraction; often neurologically intact because the fracture decompresses the canal; classified by Levine-Edwards system.

Anterior surgical approach to the pelvis through three windows (medial, middle, lateral) allowing access to the anterior pelvic ring, anterior column, and quadrilateral plate; used for anterior acetabular fractures.

Standard classification of acetabular fractures into five elementary (posterior wall, posterior column, anterior wall, anterior column, transverse) and five associated patterns; guides surgical approach.

Posterior surgical approach to the hip and acetabulum through the gluteus maximus; used for posterior wall and posterior column acetabular fractures.

The combination of hypothermia, acidosis, and coagulopathy in trauma patients that creates a self-perpetuating cycle of haemorrhage; DCO aims to prevent this triad.

Coordinated four-person technique for turning a spine-injured patient as a rigid unit to maintain neutral spinal alignment; the team leader commands from the head using in-line cervical stabilisation.

Nerve bundle formed by L4-L5 fibres running anterior to the sacroiliac joint; at high risk in posterior pelvic ring disruptions, injury causes foot drop and sensory loss.

Hand-placement technique at the head maintaining the cervical spine in neutral position without traction; used during log-roll, intubation, and procedures to prevent cervical cord injury.

Pre-arranged haemorrhage-resuscitation protocol providing packed red cells, fresh frozen plasma, and platelets in a balanced ratio (typically 1:1:1) to prevent dilutional coagulopathy.

A closed degloving injury where skin and subcutaneous tissue shear from the deep fascia, creating a haematoma/lymphatic fluid-filled cavity over the greater trochanter or pelvis; a surgical infection risk if unrecognised.

Haemodynamic instability following cervical or upper thoracic SCI from sympathetic denervation; characterised by hypotension with relative bradycardia and warm peripheries — the opposite of haemorrhagic shock.

The most caudal spinal cord segment with normal bilateral motor and sensory function; used with ASIA grade to characterise the injury.

A pelvic fracture with a wound communicating through the perineum, vagina, or rectum; carries 30-50% mortality from infection and haemorrhage; requires emergency antibiotics, colostomy, and serial debridement.

A circumferential compression device applied at the greater trochanters that reduces pelvic volume and tamponades venous haemorrhage; most effective for APC open-book injuries.

The rigid bony and ligamentous structure formed by the two innominate bones, pubic symphysis, and sacrum with bilateral sacroiliac joints; disruption risks catastrophic haemorrhage.

A minimally invasive technique for posterior pelvic ring fixation; a cannulated screw is inserted across the sacroiliac joint under fluoroscopic guidance during definitive stabilisation.

Resuscitation strategy accepting a systolic BP of 80-90 mmHg until surgical haemorrhage control is achieved, to avoid dislodging clot and diluting coagulation factors; avoided in head injury patients.

Maintaining MAP ≥85-90 mmHg for 7 days after acute SCI to optimise spinal cord perfusion pressure; preventing hypotension is one of the highest-impact neuroprotective interventions in the acute phase.

Articular cartilage degeneration following intra-articular fracture (acetabular, distal radius, tibial plateau); a long-term sequela driving the need for anatomical reduction of acetabular fractures.

Surgical technique placing gauze packs in the space of Retzius and paravesical spaces through a small suprapubic incision to tamponade venous pelvic haemorrhage not controlled by binder or angioembolisation.

The extensive venous network lying anterior to the sacrum; its disruption in posterior pelvic ring injuries accounts for 85-90% of pelvic haemorrhage.

Systematic protocol in SCI care including 2-hourly turns using log-roll, low-air-loss or alternating pressure mattress from day 1, and skin inspection at every turn; a preventable catastrophe that risks sepsis in insensate patients.

Preservation of any motor or sensory function at sacral segments S4-S5 (perianal sensation, voluntary anal contraction, big toe flexion); its presence classifies the injury as incomplete with better prognosis.

Damage to the spinal cord resulting in motor, sensory, or autonomic dysfunction below the level of injury; may be complete (no sacral preservation) or incomplete (any preserved function at S4-S5).

Transient cessation of all reflex and voluntary cord function below the injury level following acute SCI; resolves over days to weeks; return of the bulbocavernosus reflex marks its end.

The T12-L2 region where the rigid thoracic spine transitions to the more mobile lumbar spine; concentrates bending stress and accounts for ~60% of all traumatic spinal fractures.

Concept dividing the spine into anterior column (anterior vertebral body + ALL), middle column (posterior vertebral body + PLL), and posterior column (facet joints, spinous processes, posterior ligaments); disruption of ≥2 columns = instability.

A classification of pelvic ring injuries (Types A/B/C) based on posterior ring integrity and resultant stability; Type C = completely unstable (rotational and vertical).

Three-domain scoring system (morphology + posterior ligamentous complex + neurological status) guiding conservative (≤4) vs surgical (>4) management of thoracolumbar fractures.

A rigid or semi-rigid brace (Boston, Knight-Taylor, or custom-moulded) used in conservative management of stable thoracolumbar fractures to maintain spinal extension and permit mobilisation.

Pelvic fracture pattern from axial loading (fall from height) causing cranial displacement of one hemipelvis; all posterior stabilisers are ruptured, producing massive haemorrhage.

Mechanism-based pelvic fracture classification (LC/APC/VS/CM) that predicts injury pattern, haemorrhage severity, and associated organ damage.