Part 1 Flashcards
Should we take xrays of the skull?
No, less than 10% of skull fractures are detected on xray
skull anatomy is very complex
interpretation is very difficult
what does the patient need if you suspect a skull fracture?
CT
tripod fracture
when all 3 major attachments of the zygoma are separated from the rest of the face
what are the requirements for spine trauma xrays?
xrays must be of diagnostic quality
need appropriate views
old films can be helpful
what are the different mechanisms of trauma?
hyperflexion** hyperflexion and rotation hyperextension hyperextension and rotation vertical compression lateral flexion
what are the different types of hyperflexion injuries?
compression fracture bilateral interfacial dislocation flexion teardrop fracture clay shoveler's fracture anterior subluxation dens fracture
what are the types of hyperflexion and rotation injuries?
unilateral interfacetal dislocation
unilateral interfacetal fracture-dislocation
hyperextension fractures
avulsion of anterior tubercle of C1 hyperextension fracture-dislocation hyperextension dislocation posterior arch fracture of C1 extension teardrop fracture hangman's fracture lamina fracture dens fracture
hyperextension rotation fractures
pillar fracture
pedicolaminar fracture
vertical compression fractures
jeffersons fracture of C1
bursting fracture of lower cervical spine
lateral flexion fractures
unilateral fracture, lateral mass of C1
transverse process fracture
uncinate fracture
where are the most common spinal traumas?
C1-2
C5-7
T12-L1
what percentage of cervical traumas end up with neurological injury?
40%
what percent of spinal traumas end up with spinal cord injuries overall?
10-14%
what percent of thoracolumbar traumas end up with neurological injury?
10%
if you suspect cervical spine trauma, what should you do?
take a 7 view cervical spine series
“Davis series”
what is included in the 7 view cervical spine series?
lateral APOM AP cervical right and left obliques flexion and extension swimmers
what should you do if you have a diagnosis before you finish the entire 7 view cervical series?
stop and take care of it
when is a fracture stable or unstable?
unstable: middle column, 2 or more columns
stable: anterior column only, posterior column only
what if you have a new spinal fracture?
orthopedic consult
how do you treat a stable injury?
more conservatively
retropharyngeal space
7mm
retrotracheal space
22mm
signs of spine trauma (abnormal vertebral alignment)
misalignment loss of lordosis acute kyphotic angulation widened interspinous spaces vertebral rotation torticollis
signs of spine trauma (abnormal joints)
increased ADI
abnormal disc height
widened apophyseal joints
other signs of spinal trauma
vacuum cleft disc
an angle of 11 degrees or more of flexion compared to adjacent levels
greater than 3.5mm body offset maybe a clue to instability
radiographic features of severe sprain
widening of interspinous distance
loss of parallelism between facet joints
horizontal displacement
angular displacement of greater than 11 degrees compared to adjacent interspaces
antero/retrolisthesis can be due to:
fracture dislocation ligamentous laxity DJD anatomic physiologic
how fast can spinal fractures heal?
3-6 months
body fractures heal more with..
fibrosis
arch fractures heal more with
callus
posterior arch fracture
MC fracture of atlas
usually bilateral and vertical in orientation
hyperextension mechanism
other name for jefferson’s fracture
bursting fracture of C1
what is jefferson’s fracture?
axial compression injury
bilateral fracture of anterior and posterior arches
bilateral lateral mass offset
when is a jefferson’s fracture definitely unstable?
when the transverse ligament is torn (>7mm)
when is ADI most common
RA
traumatic rupture is ___in ADIs
rare
ADIs are considered..
unstabile
what do you do when you find an increased ADI?
DON’T adjust
orthopedic consult
what are the max ADIs for children and adults?
children: 5mm
adults: 3mm
what are some etiologiesfor ADIs
normal variant trauma down's syndrome major UC anomaly inflammatory arthropathies
what should you do if there is an increase in ADI
take flexion and extension films
which film is better for seeing ADIs, flexion or extension?
flexion
steele’s rule of thirds
ring of atlas is 1/3 cord 1/3 odontoid 1/3 potential space anterior displacement may be asymptomatic
40-50% of axis fractures are..
dens fractures
name the types of odontoid fractures and how common they are
type I: oblique fx of the tip (4%)
type II: fx at the base (66%)
type III: fx into the body 30%)
type I dens fractures are stable or unstable?
stable and rare
type II dens fractures are stable or unstable?
unstable and most common
type III dens fractures are stable or unstable?
unstable when broken
stable when healed
which dens fracture are non unions common?
type II
what is disrupted with type III dens fractures?
Harris’ ring
describe type I dens fx
uncommon
avulsion of the tip
distraction by apical or alar ligament
describe type II dens fx
transverse or oblique fx through base
best seen on APOM
nonunion very cmmon
unstable
if the dense is more than 5mm displaced in a type II dens fx, what does that mean?
100% nonunion
T/F: most os odontoideum are old ununited dens fx
true
T/F: most old ununited dens fx are os odontoideums
false
describe type III dens fractures
below junction of dens and C2 body mechanically unstable may disrupt Harris' ring altered body contour "fat C2 body" best seen on lateral may need specialized again
