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Diagnostic Imaging II Exam One > C1/C2 Fractures > Flashcards

C1/C2 Fractures Flashcards

1
Q

What is usually the mechanism of injury for a posterior arch fracture?

A

Hyperextension

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2
Q

What is the differential diagnosis for a posterior arch fracture?

A

Focal agenesis

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3
Q

What is the normal pattern and distribution of a posterior arch fracture?

A

Bilateral and vertical

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4
Q

What age population is more likely to have upper cervical fractures and why?

A

Elderly (due to orthostatic hypotension in the morning leading to face plant falls)

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5
Q

Why are neurological symptoms not usually seen with a posterior arch fracture?

A

Spinal canal actually widens therefore no compression on cord

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6
Q

What is the most common fracture of atlas?

A

Posterior arch fracture

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7
Q

What is a common cause of a posterior arch fracture in today’s society?

A

Rear end collision (MVA)

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8
Q

What is the differential diagnosis for a posterior arch fracture?

A

Focal agenesis

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9
Q

Why are posterior arch fractures not usually associated with neurological symptoms?

A

Spinal canal is WIDENED not narrowed

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10
Q

What is another name for a Jefferson fracture?

A

Bursting Fracture (C1)

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11
Q

What is the most common axial compression injury?

A

Jefferson Fracture

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12
Q

How many fractures make up the bursting fracture of C1?

A

Usually 4 (sometimes) 3: both the anterior and posterior arch

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13
Q

What film is used to diagnosis a Jefferson fracture?

A

APOM

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14
Q

What soft tissue is jeopardized with a Jefferson fracture?

A

Transverse atlantal ligament (unstable)

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15
Q

At what point does a Jefferson fracture become mechanically unstable?

A

If lateral masses are displaced more than 7mm (transverse atlantal ligament would be torn)

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16
Q

What is the maximum normal limit for the retropharyngeal space?

A

7mm

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17
Q

What mechanism causes an avulsion fracture of the anterior tubercle of atlas?

A

Hyperextension

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18
Q

Atlantoaxial dislocations are usually associated with what condition?

A

Rheumatoid arthritis (increased ADI)

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19
Q

What is the best view to assess for an increased ADI?

A

Cervical flexion

20
Q

What “rule” divides the ring of atlas into 3 parts?

A

Steele’s Rule of Thirds

21
Q

What are the 3 parts of Steele’s Rule of Thirds?

A

1/3 cord, 1/3 odontoid, 1/3 potential space

22
Q

What is the most common type of fracture to occur at C2?

A

Odontoid fracture (40-50%)

23
Q

What type of dens fracture is the most common?

A

Type II (66%)

24
Q

What are the locations of all 3 types of dens fractures?

A

Type I = oblique fracture of tip
Type II = fracture at base
Type III = fracture into body

25
Q

Which type of dens fracture has os terminale as a differential diagnosis?

A

Type I

26
Q

Which type of dens fracture causing a disruption of Harris’ ring?

A

Type III

27
Q

Which type of dens fracture is the most unstable?

A

Type II (type III also unstable when displacement is present)

28
Q

Which type of dens fracture is stable?

A

Type I

29
Q

Which type of dens fracture can be both stable or unstable?

A

Type III (depends on degree of displacement)

30
Q

What are the differential diagnoses for odontoid fractures (mostly type II/III)?

A

Os odontoideum, mach effects

31
Q

What causes an avulsion fracture of the odontoid tip (Type I odontoid fracture)?

A

Distraction by apical or alar ligaments

32
Q

At what age does the normal ossification center at the tip of the dens disappear?

A

12

33
Q

How can we tell the difference between an os terminale or a type I odontoid fracture?

A

Cortex lining = os terminal or old fracture; jagged edges mean acute fracture

34
Q

A type II odontoid fracture is best seen on what X-ray view?

A

APOM

35
Q

A type II odontoid fracture must be displaced how much to be considered incapable of healing by itself and therefore requiring intervention?

A

More than 5mm

36
Q

What is unique about the majority of os odontoideums?

A

Most are old ununited dens fractures

37
Q

What is the most important thing to consider with any case of a type II odontoid fracture?

A

Atlantoaxial instability

38
Q

CT imaging is done in what plane?

A

Axial

39
Q

If a type II dens fracture is suspected, what further imaging should be done to confirm and why?

A

CT (both CT and fracture are found in the axial plane)

40
Q

On which view is a type III odontoid fracture best seen?

A

Lateral

41
Q

Why do C2 odontoid fractures most commonly occur at the base?

A

Area of least cortex (thinnest)

42
Q

What is a Hangman’s fracture?

A

Bilateral pedicle fractures of C2

43
Q

What mechanism causes a Hangman’s fracture?

A

Hyperextension

44
Q

What type of displacement results with a Hangman’s fracture?

A

Anterior displacement of C2

45
Q

Are neurological symptoms present with a Hangman’s fracture?

A

No (canal is widened by anterior displacement)

46
Q

What soft tissue mass can be increased with a Hangman’s fracture?

A

Retropharyngeal space (should be less than 7mm)

Diagnostic Imaging II Exam One (5 decks)

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