cervical trauma Flashcards
1
Q
Xray findings for bifacet dislocation?
A
- Anterior translation of superior vertebrae on the inferior vertebrae
- loss of posterior border
- inferior facets of above vertebrae anterior to superior facets of below vertebrae
2
Q
what are your concerns for a patient with a bilateral facet joint dislocation?
A
- 50% associated with neurological deficit
- 10% have a fracture elsewhere
- spinal shock
3
Q
how do you manage spinal shock?
A
- IV fluid
- ionotropes and ICU - supportive treatment
4
Q
how do you manage a patient with a facet joint dislocation
A
- ATLS guidelines - perform primary survey to identify and treat life threating injuries
- Perform secondary survey
- Spinal assessment - aim to protect the cord and maintain cord perfusion
- ensure patient adequately fluid resuscitated, oxygen and catheterised
- supine on spinal board and triple immobilisation (rigid collar, sandbag and tape)
- neurological examination and ASIA grading
- trauma CT series - mechanism and other injuries
- Early referral to spinal unit
5
Q
how do you reduce the dislocation?
A
6
Q
when do you get a MRI for patients with a bifacet dislocation?
A
patients should have an MRI when:
* no neurological deficit and awake
* unconcious or uncooperative
Reduction followed by MRI:
* neurological deficit - reduction should relieve the deficit
7
Q
what should you do if closed reduction is unsuccessful?
A
- convert to an open reduction
- posterior approach
- clamps on spinous processes to distract and reduce
- posterior instrumentation
8
Q
what are the surgical options for fixation?
A
9
Q
how would you fix a C7 fracture through all 3 columns?
A
- posterior approach
- lateral mass screws in cervical vertebrae (pedicles too small)
- pedicle screws in thoracic vertebrae
- ank spond - 3 levels above and below
- Anterior decompression next if required
