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fractures and luxations/subluxations Flashcards

1
Q

The most common cause of thoracolumbar burst fractures?

A

Substantial Axial loading force

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2
Q

What two types of fractures has predilection for the thoracolumbar spine?

A
  • Burst frx
  • vertebral body
  • axial load
  • failure of anterior and middle column
  • Compression frx
  • anterior column involved
  • middle column intact
  • usually stable frx.
  • typically fall in elderly or osteoporotic pt.
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3
Q

What is a AOD?

A

Atlantooccipital dislocation

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4
Q

WHat is the treatment of an atlantooccipital dislocation?

A
  1. Immidiately IMMOBILISE.
    Obs Traction has a 10% risk of deterioration.
  2. Internal fixation and arthodesis ( fusion)
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5
Q

What can NOT be done in an AOD? How big is the risk

A

Traction - 10% risk of deterioration.

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6
Q

Another name for arthrodesis

A

fusion

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7
Q

What happens in a bulbo-cervical dissociation?

A

Occurs in injuries of C3 or above. Eg AOD.
* Immidiate pulmonary and cardiac arrest
* Death if CPR is not started within minutes.
* Usually quadriplegic and ventilator dependent

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8
Q

What cautions and contraindications are there for emergent decompressive spine surgery in SCI?

A

CAUTION: Often needed to be combined w stabilization.
CONTRAINDICATIONS:
* complete SCI more than 24h in the abscence of spinal shock. (test bulbous cavernous reflex)
* medically unstable patient
* central cord syndrome - BUT THIS IS CONTROVERSIAL

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9
Q

Contraindications for closed reduction in the spine

A
  • Atlantooccipital disslocation (10% deterioration risk)
  • Hangman type IIA or type III.
  • Skull defect/frx at the anticipated site of the pin for reduction.
  • caution in children under 3yo
  • caution in elderly
  • demineralised skull
  • additional rostral injury
  • Patients w movement disorders
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10
Q

What general group of muscles are innervated by C1-C4?

A

neck muscles.

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11
Q

Name 3 tyopes of atlantoaxial subluxations

A
  1. Rotatory - seen in children
  2. Anterior - AAS - anterior atlantoaxial subluxation - 33% of these get a deficit or die.
  3. Posterior - Rare. usually from erosion of the odontoid. - unstable and requires fusion.
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12
Q

How is a anterior atlantoaxial subluxation required?

A

Disruption of TAL - transverse atlantal ligament
Or from an incompetent odontoid process.

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13
Q

What is the most important ligament for stability in the occipitoatlantoaxial komplex?

A

The Transverse atlantal ligament.

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14
Q

the most common frx location in motorcycle injuries?

A

Th6 (upper thoracical spine)

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15
Q

Where are Jefferson frx localised?

A

In Atlas.

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16
Q

How many % of cervical spine frx are axis frx?

A

20%

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17
Q

What is the most common axis frx?

A

Odontoid frx.

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18
Q

Where are hangman frx localized?

A

To axis.

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19
Q

Are odontoid frx dangerous?

A

“die or live good” frx.

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20
Q

WHat is the grading score for odontoid frx?

A

Anderson and D’Alonzo

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21
Q

How common are flexion injuries of the subaxial cervical spine?

A

15% of cervical spine trauma.

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22
Q

What is a prototypical accident to cause subaxial flexion injury?

A

Compression-flexion as a dive on shallow water.

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23
Q

What is a teardrop frx?

A

A teardrop just beyond the anterior inferior edge of the injured vertebra.
Caused by hyperflexion or axial load at vertex of the skull with flexed neck.

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24
Q

What is important to look for in teardrop frx?

A

If the inferior margin of the frx vertebrae is displaced into the canal = Unstable.

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25
Q

What is a hyperextension avulsion frx?

A

A simple avulsion frx might also cause a small ship of bone off the anterior inferior VB, usually pulled off by traction of the anterior longitudinal ligament.

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26
Q

How to distinguish between a teardrop frx and an avulsion frx?

A

Probably avulsion:
* neurological intact
* smaller size of bone fragment
* No malalignment of VB
* No evidence of frx in sagittal plane
* No posterior element frx on XR/CT
* No prevertebral soft tissue swelling in front of frx vertebra
* No loss of VB height or disc space height

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27
Q

If everything speaks for an extension-avulsion frx - what does greenberg suggest to do w the pt?

A

*Make a flexion-extension XR. if ok
* Discharge w rigid collar. * New CT once pain subsided

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28
Q

Why is a new CT after pain subsided important in ext-avulsion fractures?

A

To rule out that a musclespasm didnt maintain alignment and a teardrop frx is the actual cause.

29
Q

How are teardrop frx treated?

A

Most often surgically. If disc and ligament are intact, a halo might be an option.

30
Q

What approach is used for teardrop frx (disrupted anterior ligament etc)

A

Anterior and posterior approach.

31
Q

WHat type of injury causes locked facets?

A

unilateral - flexion and rotation
bilateral - hyperflexion

32
Q

How many % of patients are intact after a unilateral locked facet?

A

25%

33
Q

How many % of patients have a root deficiency, an incomplete cord injury and a complete paraplegia after unilateral locked facet injury?

A

37%, 22% and 15% respectively.

34
Q

How many patients with a bilateral locked facet injury have a complete quadriplegia?

A

65-90%

35
Q

Why is an MRI absolute indication before closed reduction of a locked facet?

A

If there is a herniated disc in the area, closed reduction is ABSOLUTE CONTRAINDICATED.

36
Q

With a unilateral locked facet - in what direction does the head have to be rotated to solve the problem?

A

TOWARDS the side of the locked facet. (with axial traction)
Obs in Europe this will always be done under anesthesia and flouroscopy for a relaxed muscle situation and no panic.

37
Q

What are the two options to manual reduction of locked facetts?

A
  1. posterior surgery - will not help the disc
  2. anterior surgery - the disc will be removed and then manual traction applied.
38
Q

What is SCIWORA?

A

spinal cord injury w/o radiographic abnormality.

39
Q

What agegroup get SCIWORA?

A

1.5-16 yo. Peak 9.

40
Q

Describe SCIWORA

A
  1. +Lhermittes sign, transient numbness, paresthesias, total body weakness.
  2. between 30min to 4 days after onset—objective sensorimotor signs.
41
Q

What is the treatment of SCIWORA?

A
  • External immobilisation until free of symptoms (up to 12weeks)
    Avoidance of “high risk” activities 6mo.
42
Q

In what levels can a transverse process injury be a problem?

A

L4-L5 - lumbosacral plexus injuries and renal injuries might be associated.
T1-T2 - Risk of brachial plexus injuries.

43
Q

What ttype of frx is usually in Th10-L2 and caused by axial load with a 50% risk of deficit and 5% paraplegia?

A

Burst fractures.

44
Q

What is a “Chance frx”?

A

Its a horizontal, classically 1 level frx purely involving bone; splitting the spinous process, lamina, pedicles and VB.

45
Q

What is ligamentotaxis?

A

It is a technique to “pull” the fragments back to normal position.

46
Q

What type of injury is an atlanto-occipital dislocation?

A

A ligamentous injury.

47
Q

Why is it important to immidiately immobilize someone with atlanto-occipital dislocation? (2/3 are children)

A

Traction might lead to bulbar-cervical dissociation and cruciate paralysis, respiratory arrest, anoxia and death.

48
Q

There are three types of atlas frx. Type 2 is a so called burst fracture that is used to be called something else. What?

A

Jefferson frx.

49
Q

What is usually the cause of Jefferson frx?

A

Axial load - blow out frx.

50
Q

How many % of Jefferson frx also involve a C2 frx?

A

44%

51
Q

Where is C1 injured in an Jefferson frx?

A

Several points of the ring.

52
Q

What part of C1 is injured in a Type 3 frx?

A

The lateral mass.

53
Q

Where is a Hangman frx situated?

A

In pars articularis of C2 (pedicles). - causing disruption of C2-C3 junction. (compression of posterior column)

54
Q

Mechanism of injury of a hangman frx?

A

hyperextension and distraction.
Eg. classifaclly a blow on the forehead.

55
Q

What fracture is the most common odontoid fracture type?

A

Type 2 acording to Anderson Alfonzo= Transverse at base of odontoid. Unstable and at risk of non.union.
Even worse if IIa= comminution at the base.

56
Q

what is Grisel syndrome?

A

Rare cause of torticollis.
Subluxation of atlanto-axial joint due to ligamentous laxity. Young children
Follows inflammation of head/neck usually a retropharyngeal abscess. Can also be otitis media.
Ab and soft collar,

57
Q

What is TAL

A

Transverse atlantal ligament.

58
Q

what artery is important to evaluate in case of comminute frx of the axis body?

A

The vertebral artery.

59
Q

What is Mc Afees classification?

A

McAfee’s classification of acute traumatic spinal injuries is based on the three-column concept of the spine. CT is needed for an accurate assessment.

The McAfee classification describes 6 main types of fractures. A simplified version has 4 classes.

60
Q

McAfee type 1= compression fracture.
What does it mean?

A

Anterior column compressed only.
Two versions - anterior and lateral. The lateral is unkommon.
*No neurologic deficits

61
Q

McAfee type 2= burst fracture.
What does it mean?

A

Pure axial load fracture.
Compression injuries to anterior and middle column.
Mainly at thoracolumbar junction.

62
Q

WHat effect is an axial load giving on thoracic spine?

A

flexion.

63
Q

WHat effect does axial load have on lumbar spine?

A

increased extension

64
Q

McAfee type 2= burst fracture.
What does it mean?

A

Pure axial load fracture.
Compression injuries to anterior and middle column.
Mainly at thoracolumbar junction.

65
Q

what frx ?
bilateral pars interarticularis fractures at C2 and is the result of hyperextension and distraction, most commonly due to high velocity trauma

A

Hangman frx

66
Q

What is Steele’s rule of thirds for the normal dimensions of the upper cervical canal at C1?

A

one third of the canal is occupied by cerebrospinal fluid
one third of the canal is occupied by the dens
one third of the canal is occupied by the cord

67
Q

What cervical vertebra is most fractured?

A

C2 is the most commonly fractured level (~30%) with C7 being (~20%) being the second most common.

68
Q

Flexion is most common mechanism in cervical spine fractures and can result in the following injuries:

A

anterior atlantoaxial subluxation
anterior subluxation (hyperflexion sprain)
anterior wedge fracture
clay-shoveler fracture
flexion teardrop fracture
bilateral facet dislocation
hyperflexion fracture-dislocation

69
Q

A plain AP odontoid view of the cervical spine showing asymmetry and displacement of the lateral masses away from the odontoid peg is typically indicative of a…

A

Jefferson fracture

Spine (17 decks)

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