Exam 1- Spinal Trauma Flashcards
less than ___% of skull fractures are detected on xrays
10
the best imaging to detect a skull fracture is ___
CT
what type of skull fractures are the most common?
linear
a fracture of the floor of the left orbit associated with orbital emphysema
blowout fracture
fracture that involves separation of all three major attachments of the zygoma to the rest of the face
tripod fracture or zygomaticomaxillary fracture
facial fracture involving the maxillary bone and surrounding structures
Le Fort fracture
these fractures are common in facial trauma
Le Fort fractures
blood gathers between the dura mater and the brain
subdural hematoma
which subdural hematoma has a better prognosis, acute or chronic?
chronic
buildup of blood between the dura mater and the skull
epidural or extradural hematoma
epidural hematomas are present in __ to __% of head injuries
1 to 3%
__ to __% of epidural hematomas are fatal
15 to 20%
the most common mechanism of injury for spinal trauma
flexion
mechanism of injury for teardrop fracture
hyperflexion or hyperextension
mechanism of injury for clay shovelers fracture
hyperflexion
mechanism of injury for avulsion of the anterior tubercle of C1
hyperextension
mechanism of injury for posterior arch fracture of C1
hyperextension
mechanism of injury for hangman’s fracture
hyperextension
mechanism of injury for lamina fracture
hyperextension
mechanism of injury of dens fracture
hyperextension
mechanism of injury for pillar fracture
hyperextension-rotation
mechanism of injury for Jefferson’s/burst fracture
compression
aka burst fracture
Jefferson’s fracture
mechanism of injury for unilateral fracture
lateral flexion
mechanism of injury for fracture of lateral mass of C1
lateral flexion
mechanism of injury of transverse process fracture
lateral flexion
mechanism of injury for uncinate process fracture
lateral flexion
most common locations for spinal trauma (3)
C1-C2
C5-C7
T12-L1
__ to __ % of spinal trauma result in spinal cord injuries
10 to 14%
___% of cervical trauma result in neurological injury
40%
__% of thoracolumbar injuries result in neurological injury
10%
within how many hours should you consider an incident traumatic?
24-48
how many views are in a Davis series?
7
name the 7 views of the Davis series
Lateral APOM AP cervical left and right oblique flexion extension swimmers
stable or unstable? more than one column is disrupted
unstable
stable or unstable? the middle column is disrupted
unstable
if you find a spinal fracture what should you do?
refer to orthopedist
if you find an old fracture what should you do?
determine if it is stable or unstable (i.e. flexion/extension views)
at C2 the prevertebral space should be no more than __mm
7
at C3 and C4 the prevertebral space should be no more than __mm
5
at C6 the prevertebral space in adults should be no more than __mm
22
at C6 the prevertebral space in kids under 15 should be no more than __mm
14
name the 3 contour lines
anterior
posterior
spinolaminar
contour lines are invalid until the patient is how old?
7 or 8
ADI in adults should be no more than __mm
3
ADI in kids should be no more than __mm
5
most common cause of laxity of the transverse atlantal ligament
rheumatoid arthritis
2nd most common cause of laxity of the transverse atlantal ligament
rhumatoid variants (AS, enteropathic, psoriatic, reactive)
how long does a spinal fracture generally take to heal?
3-6 months
vertebral body fractures heal more with ______, while arch fractures heal more with ______
fibrosis
callus
most common fracture of the atlas
posterior arch fx
T or F
posterior arch fractures are usually bilateral
true
ddx for posterior arch fracture
focal agenesis
when is bilateral lateral mass offset normal?
in children up to 1 year
common or rare?
avulsion fracture of the anterior tubercle of atlas
rare
horizontal radiolucent line extending through the anterior tubercle
avulsion fracture
does traumatic rupture of the transverse atlantal ligament happen often?
no, rarely
T or F
if ADI is increased, upper cervical adjusting is contraindicated
true
in flexion atlas slides ______
forward
increased ADI is common in people with what genetic condition?
Down’s Syndrome
if there is an increased ADI on neutral cervical films, or you suspect one what should you do next?
take flexion extension films
what is Steele’s Rule of Thirds
divides the ring of atlas in thirds
1/3 cord
1/3 odontoid
1/3 potential space
T or F
anterior displacement of the atlas may be asymptomatic
true
are lateral mass fractures common?
no, very rare
are transverse process fractures common?
no, extremely rare
__ to __% of axis fractures are of the odontoid
40 to 50
most common type of odontoid fracture
type 2
what type of C2 fracture is at the base of the dens?
type 2
2nd most common type of odontoid fracture
type 3
type of odontoid fracture at the tip
type 1
what percentage of odontoid fractures are type 1?
4
what percentage of odontoid fractures are type 2?
66
what percentage of odontoid fractures are type 3?
30
stable or unstable?
type 1 odontoid fracture
stable
stable or unstable?
type 2 odontoid fracture
unstable
stable or unstable?
type 3 odontoid fracture
either
which two odontoid fracture types heal well?
1 and 3
nonunion is common in which odontoid fracture type?
2
nonunion occurs in about __% of type 2 odontoid fractures
64
ddx of type 2 odontoid fracture
os odontoideum mach effects (shadowing from other bones usually teeth)
disruption of harris’ ring occurs in which type of odontoid fracture?
3
at what age does the tip of the odontoid fuse?
5
type 2 odontoid fracture is best seen on which view?
APOM
T or F
most os odontoideum are old ununited dens fractures
true
type 3 odontoid fractures are best seen on what view?
lateral
oblique radiolucent line through the body of C2
type 3 odontoid fracture
traumatic spondylolisthesis of C2
hangman’s fracture
are hangman’s fractures common?
no, rare
in compression fractures, there is preservation of ____ body height
posterior
most common injury to the axial skeleton
compression fracture
in this type of fracture there is evenly decreased body height
pathologic
T or F
vertebral bodies regain height after healing from a fracture
false
most common cause of a burst fracture
diving into shallow end of a pool
the cord is largest at what levels?
C5-C6
mechanism of injury for unilateral facet dislocation
flexion/rotation
unilateral facet dislocation is seen on which view?
oblique
bow tie sign is associated with ________
unilateral facet dislocation
inverted hamburger sign is associated with _______
unilateral facet dislocation
stable or unstable?
unilateral facet dislocation
relatively stable
stable or unstable?
bilateral facet dislocation
unstable
mechanism of injury for bilateral facet dislocation
hyperflexion
bilateral facet dislocation most commonly occurs at what segments?
C4-C7
most severe injury of the cervical spine
flexion teardrop fracture
extension teardrop fractures usually occur at what segment?
C2
stable or unstable?
extension teardrop fracture
unstable
flexion teardrop fractures usually occur at what segments?
C4, C5, C6
aka clay shovelers fracture
root puller’s fracture
spinous fracture at C6, C7 or T1
clay shoveler’s fracture
clay shovelers fracture is most common at what segment?
C7
2nd most common location for slay shovelers fracture
C6
clay shovelers fracture is an avulsion fracture of the spinous due to torquing of what muscle?
trapezius
double spinous sign indicates _______
clay shovelers fracture
clay shovelers fractures occur at what part of the vertebra?
base of the spinous
stable or unstable?
lamina fracture
stable
flip for facts about pillar fractures!
not common
commonly missed
C4-C7
will not see on plain film, CT needed if one is suspected
stable or unstable?
uncinate fracture
stable
__% of thoracic and lumbar fractures occur between __ and __
T11 and L2
most common fracture of thoracics and lumbars
compression
3 common causes of compression fractures
osteoporosis
metastasis
mm
osteoporotic fractures are more common after what age
50
osteoporotic compression fractures are more common in which sex?
female
increased kyphosis from compression fractures
dowager’s hump
up to __% of bursting compression fractures cause cord injury
50
widened intrapedicular distance indicates ______
bursting compression fracture
aka lap belt fracture
chance fracture
horizontal splitting of the arch and body
chance/lap belt fracture
mechanism of injury for chance fracture
flexion distraction
most common location for a chance/lap belt fracture
L1-L3
empty vertebra sign indicates
chance/lap belt fracture
T or F
with chance/lap belt fractures there are generally no neurologic signs
true
transverse process fractures occur most often at what 2 levels
L2
L3
flip for fun transverse process fracture facts!
direct: football
indirect: divers, gymnasts
interruption of the pars
spondylolysis
interruption of the pars with anterior displacement
sponylolisthesis
spondylolisis without anterior displacement
prespondylolisthesis
anteriority without pars defects
pseudospondylolisthesis
there is a 40% prevalence of spondylolisthesis among alaskan eskimos
thats all
T or F
sponylolisthesis can exist without pain
true
displacement of spondylolisthesis is rare after age __
18
most pars fractures occur at what age range? mechanism of injury?
8-12
repetitive hyperextension
spondylolisthesis classifications 1-6
I dysplastic (congenital) II spondylolytic (isthmic) III degenerative IV traumatic V pathological VI post surgical
T or F
congenital spondylolisthesis is rare
true
T or F
congenital spondylolisthesis is never present at birth
true
sponylolytic spondylolisthesis is most common at what vertebral level?
L5
degenerative spondylolisthesis is most common at what vertebral level?
L4
is degenerative spondylolisthesis more common in males or females?
females
T or F
traumatic spondylolisthesis is rare
true
most common type of traumatic spondylolisthesis
hangman’s fracture of C2
name 3 causes of pathologic spondylolisthesis
metastasis
Paget’s
osteopetrosis
aka post surgical
iatragenic
spondylolisthesis is best detected by what line?
George’s
most sacral fractures occur near what segments?
S3 S4
T or F
you can bleed to death from a pelvic fracture
true
coccygeal fractures are best seen on what view?
lateral
most coccygeal fractures are ______in orientation
horizontal
iliac wing fractures
duverney
stable or unstable?
duverney fracture
stable
stable or unstable?
ischopubic rami fracture
stable
2 most common pelvic fractures
ischiopubic rami fracture (40%) malgaigne fracture (33%)
ipsilateral double vertical shearing fx of superior and inferior pubic rami with fx or dislocation about the ipsilateral SI joint
malgaigne fracture
what muscle is involved with an avulsion fracture of the ASIS?
sartorius
what muscle is involved with avulsion fracture of the AIIS
rectus femoris
what muscle(s) are involved with an avulsion fracture of the sichial tuberosity?
hamstrings
which avulsion fracture of the pelvis is the most common?
ischial tuberosity (hamstrings)
double vertical fracture of contralateral superior and inferior pubic rami
bucket-handle fracture
stable or unstable?
bucket handle fracture
unstable
bilateral superior and inferior rami fractures
straddle fracture
stable or unstable?
straddle fracture
unstable
aka sprung pelvis
open book fracture
diastasis of pubic symphysis and one or both SI joints
sprung pelvis/open book fracture
stable or unstable?
sprung pelvis/open book fracture
unstable
