C1 Trauma Flashcards
What is the exclusion criteria for Canadian C-Spine rules?
- non-trauma
- GCS (glascow coma scale) <15
- unstable vitals
- age <16
- acute paralysis
- known vertebral disease (eg. osteoporosis)
- previous C-spine inj
What is evaluated by part 1 of Canadian C-spine rules?
high risk factor (if YES, then radiographs)
What is evaluated by part 2 of Canadian C-spine rules?
low risk factor (if NO, then radiographs)
When is part 3 of Canadian C-spine rules used?
If no radiographs indicated by previous 2 parts
What are considered high risk factors according to Canadian C-spine rules?
- 65+ years
- fall from 3+ feet or 5 stairs
- axial load inj
- high speed MVC (>100km/hr 62 MPH) / rollover / ejection
- bicycle collision
- motorized recreational vehicle
What are considered low risk factors according to Canadian C-spine rules?
- simple rear-end MVC
- sitting position in ED
- ambulatory at any time
- delayed onset neck pain
- absence of midline C-spine tenderness
If no radiographs are indicated by parts 1 and 2 of Canadian C-spine rules, what question is asked next?
is patient able to actively rotate neck to 45 degrees bilaterally
(if UNABLE, then radiographs)
What is the term for a burst fracture of C1?
jefferson Fx
What is the mechanism of a Jefferson fracture?
axial compression
(eg. rolling MVA, diving)
What structures are damaged with a Jefferson fracture?
- Fx ant. arch
- Fx post. arch
- rupture transverse ligament
What is the stability of a Jefferson fracture?
unstable
What are the radiographic findings of a Jefferson fracture?
APOM:
- offset of lat. atlantoaxial alignment (overhang >2mm of C1 lat masses and C2 body)
- wide paraodontoid spaces
Lat:
- ^ADI
What is the clinical presentation of a Jefferson fracture?
+/ve Rust sign
What is the mechanism of a posterior arch fracture?
hyperextension (eg. rear-end MVC)
What is the stability of a posterior arch fracture?
stable (but look for other extension injuries)
What is the most common fracture of C1?
posterior arch
What is the differential diagnosis for a posterior arch fracture?
partial posterior arch agenesis
What is the Guillotine effect?
posterior arch of C1 moves anteriorly, trapping spinal cord against ant. tubercle
What are the radiographic findings of transverse ligament rupture?
^ADI
What is the mechanism of a transverse ligament rupture?
hyperflexion
What is the stability of a transverse ligament rupture?
unstable
(Guillotine effect; Steel’s rule of 1/3s)
What are other names for atlantoaxial rotary fixation?
atlantoaxial dislocation
atlantoaxial rotary subluxation
What is atlantoaxial rotary fixation?
true subluxation of C1, fixed in rotation on C2
What are the etiologies of atlantoaxial rotary fixation?
- post-traumatic (rotational)
- post-infectious (mainly children, termed Grisel syndrome)
What is the clinical presentation of atlantoaxial rotary fixation?
acute torticollis
What are the radiographic features of atlantoaxial rotary fixation?
(difficult due to torticollis)
APOM: asymmetry of paraodontoid spaces (no overhang of lat masses)
Lat: w/ or w/o ^ADI
What is the diagnosis?
Jefferson Fx
What is the diagnosis?
Posterior arch Fx
What is the diagnosis?
Jefferson Fx
What are other names for atlantoaxial rotary fixation?
- atlantoaxial dislocation
- atlantoaxial subluxation
