Article Figures & Data
Figures
- Figure 1
Scene at the site of the accident showing the crashed aircraft split into pieces.
- Figure 2
Seat layout of the flight showing the sections of the aircraft (marked in black lines as first and second break) and seat numbers of passengers who sustained spinal injuries (marked in red, patient ID as given in Table 1).
- Figure 3
A 26-year-old woman sustained an uncommon injury (patient ID No. 2) and presented with American Spinal Injury Association (ASIA) grade B injury including bowel and bladder deficits. Computed tomography image/magnetic resonance imaging showed “H”-shaped fracture of the sacrum with sacropelvic dissociation. She underwent spinopelvic fixation with decompression of S2 foramina. She started weight-bearing mobilization at as early as 4 weeks and recovered completely to ASIA grade E, including full recovery of bowel and bladder control.
- Figure 4
Case illustration of surgically managed patient (patient ID No. 5): 52-year-old man with L3 burst fracture, American Spinal Injury Association grade C injury. Short segment fixation with intermediate screw was performed with decompression.
- Figure 5
Case illustration of conservatively managed patient (patient ID No. 9 in Table 1): 24-year-old woman with multilevel dorsal level compression fractures with injuries of spinous processes, American Spinal Injury Association grade E.
Tables
- Table 1
Triage workup of all injured patients showing number of patients in each category and the list of injuries.
Triage Color Category Patients (No.) Injuries Red Immediate 17 29 skeletal injuries (predominantly lower limb fractures), 13 spinal injuries, and 2 brain injuries Yellow Urgent 19 Green Minor 7 Black Dead or dying 3 - Table 2
Table showing management of all patients with spinal injuries, length of stay in the hospital, neurological improvement, and present functional status.
No. Injury Pattern AO Class Spinal Injury Management Time to Surgery Length of Stay Neurology at Admission Neurology at Follow-up Functional Status 1 Burst fracture L3 with complete paraplegia A4 L2-L4 stabilization with intermediate screws, laminectomy, and wide decompression Day 1 45 ASIA grade B ASIA grade D Walking with support, bowel/bladder intact 2 Zone 2 sacral fracture bilateral with spinopelvic dissociation, fracture spinous process of T1, T2, T3 (Figure 3) C Spinopelvic fixation (L4-S2AI screws) and decompression Day 3 10 ASIA grade B with bowel and bladder involvement ASIA grade E Walking without support, bowel/bladder intact 3 L2 chance fracture with paraparesis B1 L1-L3 short segment stabilization with intermediate screw fixation Day 1 11 ASIA grade B ASIA grade E Walks without support, able to bend, able to climb stairs 4 L2 chance fracture with complete paraplegia, transverse process fracture L1, L2, L3, L4, L5 B1 T12-L3 instrumentation, stabilization, laminectomy, and wide decompression Day 2 45 ASIA grade A ASIA grade D Walks with support, bowel/bladder intact, able to climb up, difficulty climbing down 5 L3 burst fracture with paraparesis, fractures of left lamina and body of C7, left transverse process of L2 and L3 and spinous process and bilateral transverse process of T11 (Figure 4) A4 L2-L4 stabilization and decompression Day 2 31 ASIA grade C ASIA grade D Walks with support, not able to climb stairs, not able to do job 6 L3 chance fracture with burn injury over the back, L1-L4 spinous process fracture B1 L2-L4 stabilization and decompression Day 3 75 ASIA grade E ASIA grade E Mobilization out of bed starting with walker, functionally dependent 7 T3 chance fracture B1 Advised to have surgery but refused, managed conservatively - 4 ASIA grade E ASIA grade E Able to do all activities, mild back pain on prolonged activities 8 Fracture T3 vertebral body, fracture spinous process of T1, T2 A3 Conservative - 6 ASIA grade E ASIA grade E Able to do all activities, back pain during prolonged standing 9 Compression fracture T3, T4, T5, T6, and T7, spinous process fracture C7, T1, T2, T5, and T6 (Figure 5) B1 Conservative - 6 ASIA grade E ASIA grade E Mild back pain while lifting weight 10 T12 superior endplate impacted compression fracture A1 Conservative - 8 ASIA grade E ASIA grade E Able to do all activities, returned to work 11 Fracture right transverse process of L5 A1 Conservative - 5 ASIA grade E ASIA grade E Able to do all activities, returned to work 12 Contusion cervical spine, traumatic upper trunk brachial plexopathy (C5, C6) - Conservative
physiotherapy- 18 Left shoulder abduction grade 0/5, grip strength weak Good motor recovery On physiotherapy, difficulty in lifting object with left upper limb 13 L5 vertebrae body burst fracture A3 Conservative - 21 ASIA grade E ASIA grade E Started walking with support, not able to do job Abbreviations: ASIA, American Spinal Injury Association.
- Table 3
Master chart of patients showing patient morphology, mode of injury, associated injuries, and COVID-19 status on admission to the hospital.
No. Age/Sex Mode of Injury Seat No. COVID-19 Status on Admission Seat Belt Status Spinal Injury Associated Injuries 1 23/F Jammed under the seat 9E Negative Yes Burst fracture L3 with paraplegia Type 3 Schatzker fracture right proximal tibia, comminuted pilon fracture with bone loss right, comminuted fracture lateral malleolus with bone loss, comminuted fracture calcaneum right side, comminuted intra-articular fracture left distal femur, comminuted intra-articular fracture distal humerus left and fracture 2 24/F Jammed under the seat 23E Negative Yes Zone 2 sacral fracture bilateral “H” type with spinopelvic dissociation, fracture spinous process of T1, T2, T3 Right scapula fracture; fracture right second, third, and fourth ribs; fracture right clavicle; bilateral mild hemothorax (right > left) with underlying lung contusions 3 34/M Toppled around the seat, hanging on seat belt 15F Negative Yes L2 chance fracture with paraparesis 4 51/M Did not remember 3D Negative Yes L2 chance fracture with complete paraplegia, transverse process fracture L1, L2 ,L3, L4, L5 Type 3B open comminuted distal tibia and fibula fracture right leg, lateral malleoli fracture left ankle, fracture neck of talus left ankle,; fomminuted fracture cuboid left foot,; bilateral multiple rib fractures with hemopneumothorax; type 1 respiratory failure, right lower zone pneumonia, mild hemoperitoneum with splenic laceration 5 52/M Did not remember 12F Negative Yes L3 burst fracture with paraparesis, fractures of left lamina and body of C7, left transverse process of L2 and L3 and spinous process and bilateral transverse process of T11 Comminuted fracture proximal humerus right, comminuted fracture midshaft clavicle right, comminuted fracture scapula right, trimalleolar fracture right ankle, head injury: left subarachnoid hemorrhage with intraventricular hemorrhage, minimal hemothorax 6 36/M Did not remember 3B Positive Yes L3 Chance fracture with burn injury over the back, L1-L4 spinous process fracture Fracture right orbitozygomatic complex + right maxilla + facial lacerations, open fracture dislocation left ankle with talus bone loss left, right proximal tibia fracture, type 2 open fracture right elbow, type 2 open comminuted fracture right humerus shaft, soft tissue defect over the right lumbosacral region, left ankle and right lower aspect of leg, multiple bilateral rib fractures with bilateral hemopneumothorax on intercostal drainage in situ, fracture right distal humerus 7 31/M Sudden forward bending 3E Negative Yes T3 chance fracture, unstable spine injury 8 64/M Thrown out with the seat 12D Negative Yes Fracture T3 vertebral body, fracture spinous process of T1, T2 Minimal right pneumothorax, morel-lavallee lesion right thigh, anterior cruciate ligament and medial meniscus partial tear, supraspinatous tendinosis 9 24/F Thrown out from the seat upward 30A Negative No Compression fracture T3, T4, T5, T6, and T7; spinous process fracture C7, T1, T2, T5, and T6 10 29/M Sudden forward bending 23F Negative Yes T12 superior endplate impacted compression fracture 11 29M Sudden forward bending 14F Negative Yes Fracture right transverse process of L5 12 29/F Did not remember 28E Negative Yes Contusion cervical spine, traumatic upper trunk brachial plexopathy (C5, C6) Contusion maxilla with subcutaneous hemorrhage right, partial tear anteriomedial bundle of anterior cruciate ligament on femoral attachment left, grade 3 chondral injury patella right, grade 3 chondral injury patella left 13 28/M Did not remember 8B Negative Yes L5 vertebral burst fracture, no deficits Closed both bone forearm, comminuted fracture right, closed humerus distal shaft fracture left, closed olecranon undisplaced fracture left, closed shaft of femur fracture right, closed fracture dislocation talus left-Hawkins type 4, fracture medial malleolus left, P compartment release right forearm, fracture scapula left, multiple injuries right foot, bilateral lung contusions
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