Fractures 3 Flashcards
What is a unilateral facet dislocation?
Loss of contact between the zygapophyseal joints on one side of the inferior vertebra with the one above.
It is a Hyperflexion/rotational injury with interrupted cervical lines.
What sign is seen at the level of the facet dislocation?
Bowtie [batwing] sign
Unilateral Facet dislocation: stable or unstable condition?
Stable
How do you treat a unilateral facet dislocation?
Reduced and halo immobilization is necessary
What is a bilateral facet dislocation?
Loss of contact between the zygapophyseal joints on both sides of the inferior vertebra in relation to the one above.
It is an extreme hyperflexion injury with an interruption of all three cervical lines.
What sign is ABSENT in a bilateral facet dislocation?
Bow tie Sign
Bilateral facet dislocation: stable or unstable condition?
Unstable injury as there is a high risk of
spinal cord injury due to the severe
spondylolisthesis [c] > 50%
How do you treat a bilateral facet dislocation?
Surgery is required to reduce and fuse the unstable region.
What is a Clay-shoveler’s fracture?
Flexion avulsion fracture of the spinous process.
Oblique break through the spinous process with inferior displacement of the fragment.
What is the most common location of a Clay-shoveler’s fracture?
C7 (can be seen C6 to T2)
Clay-shoveler’s fracture: Forceful contraction of the __ and __ muscles caused by abrupt __
trapezius; rhomboid; hyperflexion
What sign is present in a Clay-shoveler’s fracture?
Double spinous sign
Clay-shoveler’s fracture: stable or unstable condition?
Stable fracture
How do you treat a Clay-shoveler’s fracture?
Rigid collar for 10 days followed by a soft collar for the next 6 weeks
What is a compression fracture?
Anterior wedge deformity of a
vertebral body.
There is Hyperflexion causing axial loading of the anterior part of the vertebral body.
Compression cervical fracture: stable or unstable?
Stable fracture unless there is
underlying pathology
How do you treat a compression cervical fracture?
Soft or rigid collar for 6-12 weeks depending on the extent of the injury and the treatment of any underlying pathology
What is a Burst fracture?
Comminuted fracture of the vertebral body.
There is axial compression resulting in circumferential displacement of the fragments.
What are the radiographic features of a Burst fracture?
- Interrupted anterior vertebral and George’s lines
- Kyphosis, spinous fanning and/or facet dislocation
- Prevertebral soft tissue swelling
Burst fracture: stable or unstable?
Unstable fracture – 85% with neurologic compromise
How do you treat a Burst fracture?
Surgical stabilization with plates and screws are needed
What is Whiplash?
Soft tissue injury to the neck usually caused by hyperextension-hyperflexion or acceleration-deceleration injury.
There is a loss of the normal lordosis.
What commonly causes whiplash injuries?
Rear-end auto collision (20-60%)
What is the treatment for whiplash injuries?
Soft tissue collar is helpful in the
acute phase and ice with early
self-mobilization
Define clinical presentation for Quebec task force Grade 0.
No physical symptoms
Define clinical presentation for Quebec task force Grade 1.
Neck pain/stiffness/tenderness only
Define clinical presentation for Quebec task force Grade 2.
Neck complaints and positive orthopedic tests
Define clinical presentation for Quebec task force Grade 3.
Neck complaints and neurologic symptoms
Define clinical presentation for Quebec task force Grade 4.
Neck complaints accompanied with fracture or dislocation
What are the radiographic features of whiplash?
- Abnormal prevertebral soft tissue
- Abnormal vertebral alignment
- Abnormal intervertebral disc
spacing
Whiplash: Abnormal prevertebral soft tissue
- Widening of the prevertebral space
- Soft tissue emphysema
- Indicating tracheal or laryngeal
injury
Whiplash: Abnormal vertebral alignment
- Loss of lordosis
- Acute kyphotic angulation
- Widening of the interspinous space
- Altered flexion patterns
Whiplash: Acute hyperflexion sprain with ligament disruption and instability
- Excessive vertebral translation
- 3.5-mm between the flexed and
extended lateral views - Localized acute kyphosis
- > 11 degrees
- Interspinous widening
- > 2-mm indicates instability
- Definitive when >1.5x
- Facet gapping
Whiplash: Abnormal intervertebral disc space
- Acute disc widening
- Annular vacuum cleft
Whiplash
What is an Articular Pillar fracture?
There is a loss of articular pillar height due to hyperflexion with lateral flexion.
What is the most common location for an articular pillar fracture?
C4-C7, usually unilateral
What is the DDx for asymmetric pillars?
Asymmetric pillars
What are the best views for looking at an articular pillar fracture?
Obliques or pillar
views
CT would be more informative
What is the purpose of the 3 Column Theory of Denis?
Important in determining
stability of the spinal fracture
3 Column Theory of Denis: Anterior Column
Anterior 2/3 of the vertebral body
3 Column Theory of Denis: Middle Column
Posterior 1/3 of the vertebral body
3 Column Theory of Denis: Posterior Column
Posterior elements
3 Column Theory of Denis: What is considered stable?
Fracture of 1 column (Compression fracture)
3 Column Theory of Denis: What is considered unstable?
2+ columns is unstable fracture (Burst fracture)
* Increased risk of neurologic injury
* May need surgical intervention
3 Column Theory of Denis: Will the middle column fracture by itself?
No; Exception is a posterior limbus bone
Describe the MOI of a compression fracture.
Axial compression with flexion
What are the common demographics for a compression fracture?
- Female 40+ with postmenopausal
osteoporosis (35%) - Secondary osteoporosis (30%)
- Acute trauma (25%)
What is the most common location for a compression fracture?
T11-L1
Describe a thoracolumbar compression fracture.
- Axial compression with flexion
injury - Most present with a wedge-shape
- Rarely associated with neurologic
injury
Describe a midthoracic compression fracture.
- Axial compression with flexion
injury - Biconcave shape
- Common in older female patients
- Rarely associated with neurologic
injury
Acute compression fracture injury is considered if ___ (3)
zone of impaction, step defect or paraspinal edema is present
What is a Burst fracture?
It is a fracture that involved 2-3 columns (middle column must be involved) and is caused by axial compression with flexion.
A neurologic injury in 50% of patients
What are the radiographic findings for a Burst fracture?
Compression fracture with –
* Retropulsion of the body fragments
* Vertical splitting of the vertebral body
* Comminution of the vertebral body
* Focal interpediculate widening
- Indicates posterior element fracture
What is the follow up for a Burst fracture?
- Stabilize the patient; 911 for
ambulance transport - CT for osseous fragments
- MRI for cord/nerve root injury
Describe an Anterior Limbus Bone.
- Herniation of the nucleus pulposis
through the secondary ossification
center - Before the age of 18
- Considered to be asymptomatic and
incidental findings
What is a DDx for an Anterior Limbus Bone?
Intercalary bone
* Teardrop fracture (cervical spine)
Describe a Posterior Limbus Bone.
- Exception to Denis 3 column theory
- Involves the middle column only
- Concern for neurologic compromise from stenosis
- Can be subtle; can be seen through the IVF
- CT would be better
Describe a Transverse Process Fracture.
Direct blow or extension with
lateral flexion
2nd Most common lumbar fracture
What is a DDx for a Transverse Process fracture?
Ununited secondary ossification center
What are the complications of a transverse process fracture?
- Ureter or kidney damage (20%)
- With or without hematuria
- Requires abdominal CT with IV contrast
- Heterotopic ossification
- Lumbar osseous bridging syndrome (LOBS)
Describe a Pars interarticularis fracture.
- Most are fatigue fractures
- Discussed with spondylolisthesis
- Acute traumatic fracture is
uncommon - Seen with a hyperextension-based
injury
Describe a Chance fracture (Lap-belt fracture).
- MOI: Flexion and distraction over a fulcrum (seatbelt)
- Associated injury to the spleen, pancreas, aorta, and viscera
Chance fracture: stable or unstable?
Unstable fracture
What are the radiographic features of a Chance fracture?
- Compression fracture involving the anterior column
- Distraction fracture involving the middle and posterior columns
- Horizontal split of the:
1. Posterior vertebral body
2. Spinous process
3. Pedicles (Empty vertebra sign)
Describe a Sacrococcygeal fracture.
- Sacral fractures> coccyx fractures
- MOI:
- Fall on buttocks
- Direct trauma
- Associated with other pelvic trauma
Describe a Horizontal/transverse Sacrococcygeal fracture.
Most common Sacrococcygeal fracture best seen on lateral view.
Commonly seen at 3rd and 4th sacral level.
Can be hard to see.
Horizontal/transverse Sacrococcygeal fracture: stable or unstable?
Isolated fracture is stable
Presacral space in children
<5 mm
Presacral space in adults
<20mm
Describe a Vertical Sacrococcygeal fracture.
- Indirect trauma to the pelvis
- i.e Fall from a height and land
on one ischial tuberosity
What percentage of Vertical Sacrococcygeal fractures are associated with pelvic organ?
50%
What view(s) do you use to look at Vertical Sacrococcygeal fractures?
Seen ONLY on an AP view
* Disruption/distortion of the
arcuate line
Describe a Coccygeal Sacrococcygeal fracture.
Most of these fractures are transverse and anterior displacement is common.
May subluxate of dislocate at the sacrococcygeal joint.
What view(s) do you use to look at Coccygeal Sacrococcygeal fractures?
Best assess on the lateral view
