Fractures Flashcards
What is spondylolysis?
Break drown of a bone typically a stress fracture of the Pars Interarticularis. This can lead to spondylolisthesis (slippage of a vertebrae body).
They are common, especially in sports people who do a lot of hyperextension movements.
This shouldn’t cause a lot of pain or disability.
Hx of spondylolysis
Most are asymptomatic; pain in the lower back with occasional radiation to the posterior thigh and aggravated by extension.
What are the signs of spondylolysis?
Exaggerated lordosis, heart-shaped buttock, or midline ‘step-off’ of the spinous processes may be present; pain with single-leg hyperextension test may be present (this test has low sensitivity and specificity; a combination of findings are required for diagnosis)
What are the investigations for spondylolysis?
Plain x-rays: Linear lucency in the pars interarticularis
MRI- acute stress reaction in the pars interarticularis.
What are compression fractures?
Most osteoporotic spinal compression fractures represent an isolated failure of the anterior spinal column due to a combination of flexion and axial compression loading.
The stability of the spine is not compromised with this type of fracture. These fractures are traditionally considered benign injuries that heal without complications.
Rarely, osteoporotic compression fractures can also involve the middle and/or posterior spinal columns, in addition to the anterior column. This type of fracture is potentially unstable and requires surgical intervention.
Hx of compression fractures
Advanced age- vertebral compression fracture increases six fold from menopause to age 85 years.
Previous compression fracture especially women.
Acute back pain usually from atraumatic activities such as standing from a seated position, bending forwards, or coughing and sneezing.
Incidental finding on CXR and AXR as patients can be asymptomatic at the time of diagnosis.
Hx of long-term corticosteroid use.
Kyphotic deformity.
Loss of lumbar lordosis.
What are the risk factors for compression fractures?
Older age. Previous compression fracture. Low body weight. Recent weight loss. FHx of low bone mass. Smoking.
What are the investigations for compression fractures?
Plain x-rays
- Lateral view shows wedging of anterior vertebral body and local kyphosis.
- Anteroposterior view may show interpedicular widening and/or spinous process malalignment suggesting posterior vertebral body involvement.
What is the treatment for anterior column compression fractures?
Anterior column involvement only
-Limited bed rest- prolonged immobility should be avoided, as this only increases bone loss and the risk of subsequent fractures.
-Analgesia- naproxen and paracetamol or diclofenac and paracetamol. Analgesia encourages mobilisation.
-Early mobilisation and orthosis.
-Long-term osteoporosis prophylaxis- supplement diet with calcium and vitamin D, reduce alcohol intake and stop smoking.
-Specialist pain centre referral.
2)
What is the treatment for anterior column fractures with sever unrelenting pain?
Anterior column involvement with severe unrelenting pain
-Vertebroplasty/kyphoplasty or open surgical stabilisation.
What is verterbroplasty?
Vertebroplasty involves the injection of bone cement into the vertebral body under fluoroscopic guidance and can be performed as a 1-day or overnight procedure. The mechanism of pain relief is mainly from fracture stabilisation, although thermal and chemical ablation of the nerve endings in the vertebral body may also contribute.
What is kyphoplasty?
With kyphoplasty, an inflatable bone tamp is first inserted percutaneously into the collapsed vertebral body under fluoroscopic guidance.
The endplates are then elevated as the tamp is inflated. The fracture is then fixed by the injection of bone cement in a manner similar to vertebroplasty.
