On the other hand, systemic effects from not stabilized spine fractures seem to be negligible when compared to long bone fractures [93]. It is evident, that in Type A fractures not seldom additional discoligamentous injuries are found, consecutively altering the classification from initial stable into unstable, which in the case of quick posterior stabilization is also addressed. If feasible, the insertion of minimal-invasive implants

limits secondary hit by lesser blood loss, check details fast approaches and minimal soft tissue injury as reported in previous studies [94, 95]. It preserves and exhibits the principles of damage control orthopaedics in spine trauma, (see Figure 3). Figure 3 Minimal-invasive percutaneous instrumentation

and secondary anterior surgery in a polytraumatized patient with burst fracture of T12. This is a case of a 32 year old male patient click here following a motor bike accident. The patient suffered from hematopneumothorax, intracapsular rupture of the liver, humeral head fracture HDAC inhibitor mechanism and moderate traumatic brain injury resulting in an ISS of 34. Following primary survey and whole body CT-Scan, the patient was transferred to the OR. A chest tube was inserted and the patient was positioned prone for primary stabilization of the type A3.3 fracture of T12 (images A-D). Closed reduction and percutaneous pedicle insertion allowed quick surgery (45 minutes) and limited surgery related injury without substantial blood loss and excessive antigen load as compared to conventional open stabilization (images E-F). After uneventful recovery, definitive anterior surgery using a thoracoscopy assisted approach was performed on day 7 post trauma

(images G-H). Follow-up at 24 months shows good operative result of the bisegmental fusion (images I-J). Type B fractures Distraction forces to the spinal column generate type B fractures. PD184352 (CI-1040) Posterior distraction injuries are often initially overseen or neglected, thus instable injuries are falsely regarded as stable and surgery is delayed. It is crucial to look out for signs of posterior distraction in these patients, since type B fractures are assigned unstable and require immediate stabilization in the primary operative phase [23, 26, 86]. To restore posterior tension banding, we use open or minimal-invasive posterior instrumentation, as mentioned beforehand. Type C fractures Axial compression or distraction forces in combination with a rotational momentum generate type C fractures. These are regarded as highly unstable and are associated with the highest rate of neurologic deficits. These fracture patterns are in need of immediate surgery, too. Although minimal-invasive percutaneous instrumentation is available, and secondary hit by limited approach related injury is favourable in the polytraumatized patient, the minimal-invasive stabilization in type C fractures plays no role, so far.