Other Cervical Fractures Flashcards
What is the most common overall injury to the axial skeleton?
Compression fractures
What mechanism usually causes compression fractures?
Hyperflexion
What body changes do we see with a compression fracture?
Decreased anterior 1-2/3 body height with preservation of posterior body height
Which endplate is usually affected by a compression fracture?
Superior endplate (depression)
Are compression fractures considered stable or unstable?
Stable until body is reduced by over 40% or more (then unstable)
What are the 3 most common causes of a pathological compression fracture?
1 osteoporosis 2 lytic metastasis 3 multiple myeloma
A present zone of impaction and/or step defect is indicative of a new or old compression fracture?
NEW
How can an MRI help figure out if a compression fracture is new or old?
Presence of marrow edema = new fracture
How can we tell a step defect from a limbus?
Step defects are displaced from the anterior margin
What happens to step defects after the healing process?
Round out and disappear
What type of force usually causes a burst fracture?
Axial compression
Which version of a teardrop fracture causes the most neurologic deficit?
Flexion teardrop
What is the major patient complaint seen with unilateral facet dislocation?
Inability to look to one side
Which mechanism is responsible for unilateral facet dislocation?
Flexion rotation
What specific anatomy is dislocated with a unilateral facet dislocation?
Interior articular process dislocates into IVF
What type of body displacement can be seen with a unilateral facet dislocation, and on which X-ray view can this be seen?
Anterior body displacement (25%), lateral X-ray
What X-ray sign is associated with a unilateral facet dislocation due to the fact that the articular pillars are not superimposed upon each other?
“Bow-tie” sign
What area of the vertebrae experience decreased length that can be seen on a lateral film with a unilateral facet dislocation?
Laminae (at segment level and up)
What direction of spinous rotation can be seen on the AP view with a unilateral facet dislocation?
Rotation toward side of dislocation
What X-ray view confirms a unilateral facet dislocation?
Obliques (to see IVF)
What CT sign can be seen with a unilateral facet dislocation?
Inverted hamburger sign
Inverted hamburger sign is associated with what condition and can be seen on what type of imaging?
Unilateral facet dislocation; CT
Are neurological deficits more common with unilateral or bilateral facet dislocations?
Bilateral (high incidence)
What is the #1 worst injury to the cervical spine? #2?
#1 = flexion teardrop #2 = bilateral facet dislocation
What mechanism causes bilateral facet dislocation injuries?
Hyperflexion
What levels are most commonly associated with bilateral facet dislocation and why?
C4-C7 (areas of stress)
How is the interspinous space affected by bilateral facet dislocation?
Increased
What sign on CT can be seen with bilateral facet dislocation?
Bilateral inverted hamburger sign
In which direction is the body likely to displace (50%) with bilateral facet dislocation?
Anteriorly
What mechanism is responsible for a flexion teardrop fracture?
Flexion
What is the most common location for flexion teardrop fracture?
C4-C7
What is the most common location for an extension teardrop fracture?
C2*/C3
Buckling of which ligament is associated with extension teardrop fractures?
Ligamentum flavum
What age population is likely to have extension teardrop fractures and why?
Elderly: falling due to orthostatic hypotension
Which is located higher in the spine: flexion or extension teardrop fractures? Lower?
Higher = extension Lower = flexion
What is another name for a Clay Shoveler’s fracture?
Root puller’s fracture
What are the usual locations for a clay shoveler’s fracture?
C7, C6 and T1
What general type of fracture is a clay shoveler’s fracture?
Avulsion
What causes a clay shoveler’s fracture?
Muscles rip spinous off during hyperflexion
What mechanism usually causes a clay shoveler’s fracture?
Hyperflexion
In what direction does the fragment involved with a clay shoveler’s fracture usually displace?
Inferiorly
The double spinous sign on X-ray is associated with which injury?
Clay shoveler’s fracture
What is the differential diagnosis for a clay shoveler’s fracture?
Secondary ossification center on spinous
What would it mean if the tip of a spinous on X-ray appears to be displaced but has smooth edges and cortex?
Probably just a failure to ossify (not fracture)
On which X-ray view do we see the double spinous sign?
AP cervical
In other areas of the spine besides the cervical region, what mechanism causes spinous fractures?
Extension (or direct trauma)
What is a good way to differentiate clay shoveler’s fractures from a simple spinous fracture that could be due to other causes?
Know the unique levels for clay shoveler’s: C7, C6, and T1
What is the mechanism of injury for laminar fractures?
Hyperextension
What is the likely area for laminar fractures?
Lower cervicals
What is a laminar buckle fracture?
“Fracture” that occurred on a mostly cartilaginous lamina that bent it instead of broke it (think peds)
What is the usual location for a pillar fracture?
C4-C7
What is the mechanism associated with pillar fractures?
Extension/compression
Why are pillar fractures difficult to see on X-ray?
Pillar naturally diminish during transition into thoracics from cervicals.
What types of fractures can occur via a lateral flexion mechanism?
Unilateral (or lateral mass of C1), transverse process, or uncinate process fracture
Why are unilateral, lateral mass, transverse process, and uncinate process fractures rare?
Lateral flexion mechanism is uncommon
Which mechanism of injury creates posterior ligament stress following whiplash? Anterior ligament stress?
Posterior = hyperflexion Anterior = hyperextension
What causes the widened interspinous spaces seen with whiplash injury?
Disrupted ligaments
