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DIAGNOSTIC IMAGING II > Fractures 2 > Flashcards

Fractures 2 Flashcards

1
Q

What is the mechanism of injury for axial loading?

A

This mechanism commonly results in burst fractures, where the vertebral body is crushed under axial force. A specific example is the Jefferson fracture, often caused by diving accidents.

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2
Q

What do flexion injuries result in?

A

Flexion injuries can result in
compression fractures or flexion
teardrop fractures.

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3
Q

Where do compression and flexion teardrop fractures commonly occur?

A

These fractures often occur at the C5-C6 level and are characterized by
anterior wedging and loss of height of the vertebral body.

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4
Q

What can hyperextension injuries lead to?

A

These can cause extension teardrop
fractures or Hangman’s fractures.

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5
Q

Where do Extension Teardrop Fractures commonly occur?

A

Extension teardrop fractures are
particularly common at C2,
resulting from an avulsion of the
anterior vertebral body due to the
pull of the anterior longitudinal
ligament (ALL).

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6
Q

What can Lateral Flexion and Rotational injuries lead to?

A

These mechanisms can cause unilateral or bilateral facet dislocations, which are associated with a high risk of spinal cord injury.

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7
Q

What can complex mechanisms of injury lead to?

A

Often involve a combination of the
above, leading to unstable injuries like burst fractures or complex dislocations that may require surgical intervention.

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8
Q

What are the consequences of C1-C4 injuries?

A

High cervical spine injuries often result in significant disability, including respiratory failure due to phrenic nerve involvements. The risk of fatal outcomes is higher with complete spinal cord injuries at this level.

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9
Q

What are the consequences of C5-C7 injuries?

A

Lower cervical spine injuries more commonly affect the brachial plexus, resulting in varying degrees of upper limb paralysis.

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10
Q

Describe a complete spinal cord injury.

A

Often associated with severe trauma, resulting in complete loss of motor and sensory function below the level of injury.

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11
Q

What is the prognosis of Brown-Sequard Syndrome?

A

Brown-Sequard has the best prognosis, with preservation of some motor
function.

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12
Q

What is the prognosis of Anterior Cord Syndrome?

A

Anterior cord syndrome has worse prognosis with complete sensory and motor loss.

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13
Q

What is the prognosis of Central Cord Syndrome?

A

Central cord syndrome is seen in elderly patients and has a favorable
prognosis.

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14
Q

Describe Posterior Cord Syndrome.

A

Posterior cord syndrome is rare and is seen with loss of proprioception and vibration.

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15
Q

Describe a Craniocervical (Atlanto-Occipital) Dislocation

A

Total loss of contact between the occipital condyles and the superior articular surfaces of the C1 lateral masses.

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16
Q

What is the MOI for a craniocervical dislocation?

A

Distractive force at the CCJ by hyperflexion-hyperextension

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17
Q

What are the radiographic features of a craniocervical dislocation?

A
  • Loss of articulation of the occipital condyles and C1
  • Increased basion-dental interval (Normal= less than 12 mm)
  • Prevertebral soft tissue swelling
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18
Q

What is the follow up for a craniocervical dislocation?

A

Follow-up with CT or MRI to assess for brainstem and spinal cord injury. Can assess the ligamentous structures of the CCJ.

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19
Q

What is the treatment for a craniocervical dislocation?

A

Rigid cervical collar or halo immobilization, airway stabilization, and fusion of the CCJ.
Contraindication to manipulation. Immediate immobilization and urgent referral to the emergency department.

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20
Q

What is a Jefferson Fracture?

A

Burst fracture of C1

21
Q

What is is MOI of a Jefferson fracture?

A

axial compression. i.e Diving into a shallow pool head first.

22
Q

What are the radiographic features of a Jefferson fracture?

A
  • Key radiographic image is the APOM view
  • Comminuted fracture involving portions of the anterior and posterior arches of C1
  • Overhanging lateral edge of the C1 lateral mass over the lateral edge of the C2 vertebral body
  • Two main types (Rule of Spence)
  • Type 1 (stable): Intact transverse ligament where the sum of the lateral displacement is less than 7 mm
  • Type 2 (unstable): Transverse ligament is ruptured, where the sum of lateral mass displacement is greater than 7 mm
23
Q

What is the follow up for a Jefferson fracture?

A

Follow-up with CT and MR imaging

24
Q

What is the treatment for a Jefferson fracture?

A

Type 1 is treated with a rigid collar and immobilization. Type 2 is treated with posterior fusion of C1/C2 or occipitocervical fusion or halo immobilization.
Contraindication to manipulation. Immediate immobilization and urgent referral to the emergency department.

25
Q

What is a Neural Arch fracture?

A

Fracture involving the posterior arch of C1. Less severe injury compared to a Jefferson fracture.

26
Q

What is the MOI of a Neural Arch fracture?

A

Hyperextension forces from a rear-end collision or a fall.

27
Q

What are the radiographic features of a Neural Arch fracture?

A
  • Fracture line is seen involving the posterior arch
  • Intact atlantodental and paraodontoid spaces
  • Soft tissue swelling
28
Q

What is the follow up for a Neural Arch fracture?

A

Follow-up with CT imaging to visualize fracture fragments

29
Q

What is the treatment for a Neural Arch fracture?

A

Treatment: Rigid collar, immobilization, and pain
management
* Surgical intervention is uncommon, unless there is signs
of instability, non-union or other associated fractures

30
Q

What is an Odontoid fracture?

A

Fracture involving the odontoid process are a critical injury due to their potential impact on spinal stability and neurological function.

31
Q

Describe a Type 1 Anderson-D’Alonzo fracture.

A

Type 1: Fracture of the cephalic tip of the odontoid process
* MOI: Flexion and extension injuries
* Stable

32
Q

Describe a Type 2 Anderson-D’Alonzo fracture.

A

Type 2: Fracture at the base of the odontoid process
* MOI: High-energy trauma such MVA and falls
* Unstable

33
Q

Describe a Type 3 Anderson-D’Alonzo fracture.

A

Type 3: Fracture extending into the C2 vertebral body
* MOI: Severe trauma with high impact collision, flexion and extension injury
* Unstable. Best prognosis for healing

34
Q

What is the treatment for an Odontoid fracture?

A

Treatment:
* Type 1 is a cervical collar or halo
* Type 2 and 3 requires surgical intervention with odontoid fixation and/or C1/C2 posterior fusion

35
Q

What is a Hangman fracture?

A

Fracture involving bilateral C2 pedicles (aka pars interarticularis)

36
Q

What is the MOI of a Hangman fracture?

A

Hyperextension injury or high-impact trauma

37
Q

What are the radiographic features of a Hangman fracture?

A

Fracture traversing through the C2 pedicle region
* Type 1: Hairline fracture involving C2 pedicle. Stable. Cervical collar and immobilization
* Type 2: Fracture of the pedicles AND disruption of the C2/C3 IVD. Unstable with possible involvement of the transverse ligament. Surgical fixation
* Type 3: Fracture of the C2 pedicles AND disruption of the C2/C3 IVD AND spondylolisthesis. Unstable. Surgical fixation

38
Q

What is the follow up for a Hangman fracture?

A

Follow-up with MR imaging to assess the spinal cord and ligamentous restraints and CT for further fracture evaluation

39
Q

What is an Extension Tear Drop fracture?

A

Fracture along the anterior-inferior aspect of a cervical vertebra, typically at C2

40
Q

What is the MOI of an Extension Tear Drop fracture?

A

Extreme hypertension of the neck

41
Q

What are the radiographic features of an Extension Tear Drop fracture?

A
  • Small triangular fragment at the anterior-inferior edge of a vertebral level
  • Prevertebral soft tissue swelling
42
Q

What is the follow up for an Extension Tear Drop fracture?

A

Follow-up with MRI to assess the spinal ligaments in particular the ALL

43
Q

What is the treatment for an Extension Tear Drop fracture?

A

Treatment requires surgical intervention due to instability and ligamentous injury

44
Q

What is a Flexion Tear Drop fracture?

A

Fracture along the anterior-inferior aspect of a cervical vertebra

45
Q

What is the MOI for a Flexion Tear Drop fracture?

A

Hyperflexion injury that forces a fracture of the anterior aspect of the vertebral body. This is often associated with spinal cord injury

46
Q

What are the radiographic features for a Flexion Tear Drop fracture?

A
  • Small triangular fracture along the anterior-inferior aspect
  • Commonly in the lower cervical spine C5-C6
  • Compression fracture may be present
  • Prevertebral soft tissue swelling
47
Q

What is the follow up for a Flexion Tear Drop fracture?

A

MRI to assess for cord injury

48
Q

What is the treatment for a Flexion Tear Drop?

A

Unstable fracture and will need surgical intervention with possible anterior decompression

DIAGNOSTIC IMAGING II (9 decks)

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