C1 Trauma

Question 1

What is the exclusion criteria for Canadian C-Spine rules?

Answer 1

• non-trauma
• GCS (glascow coma scale) <15
• unstable vitals
• age <16
• acute paralysis
• known vertebral disease (eg. osteoporosis)
• previous C-spine inj

Question 2

What is evaluated by part 1 of Canadian C-spine rules?

Answer 2

high risk factor (if YES, then radiographs)

Question 3

What is evaluated by part 2 of Canadian C-spine rules?

Answer 3

low risk factor (if NO, then radiographs)

Question 4

When is part 3 of Canadian C-spine rules used?

Answer 4

If no radiographs indicated by previous 2 parts

Question 5

What are considered high risk factors according to Canadian C-spine rules?

Answer 5

• 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

Question 6

What are considered low risk factors according to Canadian C-spine rules?

Answer 6

• simple rear-end MVC
• sitting position in ED
• ambulatory at any time
• delayed onset neck pain
• absence of midline C-spine tenderness

Question 7

If no radiographs are indicated by parts 1 and 2 of Canadian C-spine rules, what question is asked next?

Answer 7

is patient able to actively rotate neck to 45 degrees bilaterally
(if UNABLE, then radiographs)

Question 8

What is the term for a burst fracture of C1?

Answer 8

jefferson Fx

Question 9

What is the mechanism of a Jefferson fracture?

Answer 9

axial compression
(eg. rolling MVA, diving)

Question 10

What structures are damaged with a Jefferson fracture?

Answer 10

• Fx ant. arch
• Fx post. arch
• rupture transverse ligament

Question 11

What is the stability of a Jefferson fracture?

Answer 11

unstable

Question 12

What are the radiographic findings of a Jefferson fracture?

Answer 12

APOM:
- offset of lat. atlantoaxial alignment (overhang >2mm of C1 lat masses and C2 body)
- wide paraodontoid spaces
Lat:
- ^ADI

Question 13

What is the clinical presentation of a Jefferson fracture?

Answer 13

+/ve Rust sign

Question 14

What is the mechanism of a posterior arch fracture?

Answer 14

hyperextension (eg. rear-end MVC)

Question 15

What is the stability of a posterior arch fracture?

Answer 15

stable (but look for other extension injuries)

Question 16

What is the most common fracture of C1?

Answer 16

posterior arch

Question 17

What is the differential diagnosis for a posterior arch fracture?

Answer 17

partial posterior arch agenesis

Question 18

What is the Guillotine effect?

Answer 18

posterior arch of C1 moves anteriorly, trapping spinal cord against ant. tubercle

Question 19

What are the radiographic findings of transverse ligament rupture?

Answer 19

^ADI

Question 20

What is the mechanism of a transverse ligament rupture?

Answer 20

hyperflexion

Question 21

What is the stability of a transverse ligament rupture?

Answer 21

unstable
(Guillotine effect; Steel’s rule of 1/3s)

Question 22

What are other names for atlantoaxial rotary fixation?

Answer 22

atlantoaxial dislocation
atlantoaxial rotary subluxation

Question 23

What is atlantoaxial rotary fixation?

Answer 23

true subluxation of C1, fixed in rotation on C2

Question 24

What are the etiologies of atlantoaxial rotary fixation?

Answer 24

• post-traumatic (rotational)
• post-infectious (mainly children, termed Grisel syndrome)

Question 25

What is the clinical presentation of atlantoaxial rotary fixation?

Answer 25

acute torticollis

Question 26

What are the radiographic features of atlantoaxial rotary fixation?

Answer 26

(difficult due to torticollis)
APOM: asymmetry of paraodontoid spaces (no overhang of lat masses)
Lat: w/ or w/o ^ADI

Question 27

What is the diagnosis?

Answer 27

Jefferson Fx

Question 28

What is the diagnosis?

Answer 28

Posterior arch Fx

Question 29

What is the diagnosis?

Answer 29

Jefferson Fx

Question 30

What are other names for atlantoaxial rotary fixation?

Answer 30

• atlantoaxial dislocation
• atlantoaxial subluxation