Exam 1- Spinal Trauma Flashcards
1
Q
less than ___% of skull fractures are detected on xrays
A
10
2
Q
the best imaging to detect a skull fracture is ___
A
CT
3
Q
what type of skull fractures are the most common?
A
linear
4
Q
a fracture of the floor of the left orbit associated with orbital emphysema
A
blowout fracture
5
Q
fracture that involves separation of all three major attachments of the zygoma to the rest of the face
A
tripod fracture or zygomaticomaxillary fracture
6
Q
facial fracture involving the maxillary bone and surrounding structures
A
Le Fort fracture
7
Q
these fractures are common in facial trauma
A
Le Fort fractures
8
Q
blood gathers between the dura mater and the brain
A
subdural hematoma
9
Q
which subdural hematoma has a better prognosis, acute or chronic?
A
chronic
10
Q
buildup of blood between the dura mater and the skull
A
epidural or extradural hematoma
11
Q
epidural hematomas are present in __ to __% of head injuries
A
1 to 3%
12
Q
__ to __% of epidural hematomas are fatal
A
15 to 20%
13
Q
the most common mechanism of injury for spinal trauma
A
flexion
14
Q
mechanism of injury for teardrop fracture
A
hyperflexion or hyperextension
15
Q
mechanism of injury for clay shovelers fracture
A
hyperflexion
16
Q
mechanism of injury for avulsion of the anterior tubercle of C1
A
hyperextension
17
Q
mechanism of injury for posterior arch fracture of C1
A
hyperextension
18
Q
mechanism of injury for hangman’s fracture
A
hyperextension
19
Q
mechanism of injury for lamina fracture
A
hyperextension
20
Q
mechanism of injury of dens fracture
A
hyperextension
21
Q
mechanism of injury for pillar fracture
A
hyperextension-rotation
22
Q
mechanism of injury for Jefferson’s/burst fracture
A
compression
23
Q
aka burst fracture
A
Jefferson’s fracture
24
Q
mechanism of injury for unilateral fracture
A
lateral flexion
25
mechanism of injury for fracture of lateral mass of C1
lateral flexion
26
mechanism of injury of transverse process fracture
lateral flexion
27
mechanism of injury for uncinate process fracture
lateral flexion
28
most common locations for spinal trauma (3)
C1-C2
C5-C7
T12-L1
29
__ to __ % of spinal trauma result in spinal cord injuries
10 to 14%
30
___% of cervical trauma result in neurological injury
40%
31
__% of thoracolumbar injuries result in neurological injury
10%
32
within how many hours should you consider an incident traumatic?
24-48
33
how many views are in a Davis series?
7
34
name the 7 views of the Davis series
```
Lateral
APOM
AP cervical
left and right oblique
flexion
extension
swimmers
```
35
stable or unstable? more than one column is disrupted
unstable
36
stable or unstable? the middle column is disrupted
unstable
37
if you find a spinal fracture what should you do?
refer to orthopedist
38
if you find an old fracture what should you do?
determine if it is stable or unstable (i.e. flexion/extension views)
39
at C2 the prevertebral space should be no more than __mm
7
40
at C3 and C4 the prevertebral space should be no more than __mm
5
41
at C6 the prevertebral space in adults should be no more than __mm
22
42
at C6 the prevertebral space in kids under 15 should be no more than __mm
14
43
name the 3 contour lines
anterior
posterior
spinolaminar
44
contour lines are invalid until the patient is how old?
7 or 8
45
ADI in adults should be no more than __mm
3
46
ADI in kids should be no more than __mm
5
47
most common cause of laxity of the transverse atlantal ligament
rheumatoid arthritis
48
2nd most common cause of laxity of the transverse atlantal ligament
rhumatoid variants (AS, enteropathic, psoriatic, reactive)
49
how long does a spinal fracture generally take to heal?
3-6 months
50
vertebral body fractures heal more with ______, while arch fractures heal more with ______
fibrosis
| callus
51
most common fracture of the atlas
posterior arch fx
52
T or F
| posterior arch fractures are usually bilateral
true
53
ddx for posterior arch fracture
focal agenesis
54
when is bilateral lateral mass offset normal?
in children up to 1 year
55
common or rare?
| avulsion fracture of the anterior tubercle of atlas
rare
56
horizontal radiolucent line extending through the anterior tubercle
avulsion fracture
57
does traumatic rupture of the transverse atlantal ligament happen often?
no, rarely
58
T or F
| if ADI is increased, upper cervical adjusting is contraindicated
true
59
in flexion atlas slides ______
forward
60
increased ADI is common in people with what genetic condition?
Down's Syndrome
61
if there is an increased ADI on neutral cervical films, or you suspect one what should you do next?
take flexion extension films
62
what is Steele's Rule of Thirds
divides the ring of atlas in thirds
1/3 cord
1/3 odontoid
1/3 potential space
63
T or F
| anterior displacement of the atlas may be asymptomatic
true
64
are lateral mass fractures common?
no, very rare
65
are transverse process fractures common?
no, extremely rare
66
__ to __% of axis fractures are of the odontoid
40 to 50
67
most common type of odontoid fracture
type 2
68
what type of C2 fracture is at the base of the dens?
type 2
69
2nd most common type of odontoid fracture
type 3
70
type of odontoid fracture at the tip
type 1
71
what percentage of odontoid fractures are type 1?
4
72
what percentage of odontoid fractures are type 2?
66
73
what percentage of odontoid fractures are type 3?
30
74
stable or unstable?
| type 1 odontoid fracture
stable
75
stable or unstable?
| type 2 odontoid fracture
unstable
76
stable or unstable?
| type 3 odontoid fracture
either
77
which two odontoid fracture types heal well?
1 and 3
78
nonunion is common in which odontoid fracture type?
2
79
nonunion occurs in about __% of type 2 odontoid fractures
64
80
ddx of type 2 odontoid fracture
```
os odontoideum
mach effects (shadowing from other bones usually teeth)
```
81
disruption of harris' ring occurs in which type of odontoid fracture?
3
82
at what age does the tip of the odontoid fuse?
5
83
type 2 odontoid fracture is best seen on which view?
APOM
84
T or F
| most os odontoideum are old ununited dens fractures
true
85
type 3 odontoid fractures are best seen on what view?
lateral
86
oblique radiolucent line through the body of C2
type 3 odontoid fracture
87
traumatic spondylolisthesis of C2
hangman's fracture
88
are hangman's fractures common?
no, rare
89
in compression fractures, there is preservation of ____ body height
posterior
90
most common injury to the axial skeleton
compression fracture
91
in this type of fracture there is evenly decreased body height
pathologic
92
T or F
| vertebral bodies regain height after healing from a fracture
false
93
most common cause of a burst fracture
diving into shallow end of a pool
94
the cord is largest at what levels?
C5-C6
95
mechanism of injury for unilateral facet dislocation
flexion/rotation
96
unilateral facet dislocation is seen on which view?
oblique
97
bow tie sign is associated with ________
unilateral facet dislocation
98
inverted hamburger sign is associated with _______
unilateral facet dislocation
99
stable or unstable?
| unilateral facet dislocation
relatively stable
100
stable or unstable?
| bilateral facet dislocation
unstable
101
mechanism of injury for bilateral facet dislocation
hyperflexion
102
bilateral facet dislocation most commonly occurs at what segments?
C4-C7
103
most severe injury of the cervical spine
flexion teardrop fracture
104
extension teardrop fractures usually occur at what segment?
C2
105
stable or unstable?
| extension teardrop fracture
unstable
106
flexion teardrop fractures usually occur at what segments?
C4, C5, C6
107
aka clay shovelers fracture
root puller's fracture
108
spinous fracture at C6, C7 or T1
clay shoveler's fracture
109
clay shovelers fracture is most common at what segment?
C7
110
2nd most common location for slay shovelers fracture
C6
111
clay shovelers fracture is an avulsion fracture of the spinous due to torquing of what muscle?
trapezius
112
double spinous sign indicates _______
clay shovelers fracture
113
clay shovelers fractures occur at what part of the vertebra?
base of the spinous
114
stable or unstable?
| lamina fracture
stable
115
flip for facts about pillar fractures!
not common
commonly missed
C4-C7
will not see on plain film, CT needed if one is suspected
116
stable or unstable?
| uncinate fracture
stable
117
__% of thoracic and lumbar fractures occur between __ and __
T11 and L2
118
most common fracture of thoracics and lumbars
compression
119
3 common causes of compression fractures
osteoporosis
metastasis
mm
120
osteoporotic fractures are more common after what age
50
121
osteoporotic compression fractures are more common in which sex?
female
122
increased kyphosis from compression fractures
dowager's hump
123
up to __% of bursting compression fractures cause cord injury
50
124
widened intrapedicular distance indicates ______
bursting compression fracture
125
aka lap belt fracture
chance fracture
126
horizontal splitting of the arch and body
chance/lap belt fracture
127
mechanism of injury for chance fracture
flexion distraction
128
most common location for a chance/lap belt fracture
L1-L3
129
empty vertebra sign indicates
chance/lap belt fracture
130
T or F
| with chance/lap belt fractures there are generally no neurologic signs
true
131
transverse process fractures occur most often at what 2 levels
L2
| L3
132
flip for fun transverse process fracture facts!
direct: football
indirect: divers, gymnasts
133
interruption of the pars
spondylolysis
134
interruption of the pars with anterior displacement
sponylolisthesis
135
spondylolisis without anterior displacement
prespondylolisthesis
136
anteriority without pars defects
pseudospondylolisthesis
137
there is a 40% prevalence of spondylolisthesis among alaskan eskimos
thats all
138
T or F
| sponylolisthesis can exist without pain
true
139
displacement of spondylolisthesis is rare after age __
18
140
most pars fractures occur at what age range? mechanism of injury?
8-12
| repetitive hyperextension
141
spondylolisthesis classifications 1-6
```
I dysplastic (congenital)
II spondylolytic (isthmic)
III degenerative
IV traumatic
V pathological
VI post surgical
```
142
T or F
| congenital spondylolisthesis is rare
true
143
T or F
| congenital spondylolisthesis is never present at birth
true
144
sponylolytic spondylolisthesis is most common at what vertebral level?
L5
145
degenerative spondylolisthesis is most common at what vertebral level?
L4
146
is degenerative spondylolisthesis more common in males or females?
females
147
T or F
| traumatic spondylolisthesis is rare
true
148
most common type of traumatic spondylolisthesis
hangman's fracture of C2
149
name 3 causes of pathologic spondylolisthesis
metastasis
Paget's
osteopetrosis
150
aka post surgical
iatragenic
151
spondylolisthesis is best detected by what line?
George's
152
most sacral fractures occur near what segments?
S3 S4
153
T or F
| you can bleed to death from a pelvic fracture
true
154
coccygeal fractures are best seen on what view?
lateral
155
most coccygeal fractures are ______in orientation
horizontal
156
iliac wing fractures
duverney
157
stable or unstable?
| duverney fracture
stable
158
stable or unstable?
| ischopubic rami fracture
stable
159
2 most common pelvic fractures
```
ischiopubic rami fracture (40%)
malgaigne fracture (33%)
```
160
ipsilateral double vertical shearing fx of superior and inferior pubic rami with fx or dislocation about the ipsilateral SI joint
malgaigne fracture
161
what muscle is involved with an avulsion fracture of the ASIS?
sartorius
162
what muscle is involved with avulsion fracture of the AIIS
rectus femoris
163
what muscle(s) are involved with an avulsion fracture of the sichial tuberosity?
hamstrings
164
which avulsion fracture of the pelvis is the most common?
ischial tuberosity (hamstrings)
165
double vertical fracture of contralateral superior and inferior pubic rami
bucket-handle fracture
166
stable or unstable?
| bucket handle fracture
unstable
167
bilateral superior and inferior rami fractures
straddle fracture
168
stable or unstable?
| straddle fracture
unstable
169
aka sprung pelvis
open book fracture
170
diastasis of pubic symphysis and one or both SI joints
sprung pelvis/open book fracture
171
stable or unstable?
| sprung pelvis/open book fracture
unstable
