Part 2 Flashcards
if there is posterior trauma, where do we see the affected vertebra?
relatively anterior
if there is anterior trauma, where do we see the affected vertebra?
relatively posterior
describe a hangman’s fracture
bilateral pedicle fracture of C2
hyperextension mechanism
possible increased RPI
relative lack of neurological findings
other names for hangman’s fracture
traumatic spondylolisthesis of C2
bilateral pedicle fracture of C2
anterior displacement of C2
compression fracture is also known as
wedging compression fracture
describe compression fracture
flexion mechanism predominantly superior endplate may have a small anterior fragment stable zone of impaction possible
what are some helpful ways to determine a new fracture from an old fracture on am MRI?
cortical disruption blurry or hazy endplates fracture line line of impaction step defect
what is the saying to help determine a new fracture from an old fracture?
white is right, black is whack
T1
what are some ways to determine and old fracture from a new fracture?
old fracture: old films help, intact cortex
burst fracture
vertebral body “explodes” into several fragments
fragments are driven centrifugally
axial compression forces predominate
possible cord compression/CT exam
unstable
may see vertical split of the body on AP film
lateral shows comminuted body flattneed centrally
neurological infovlement is variable
unilateral facet dislocation
flexion, rotation mechanism
inferior articular process dislocates into IVF
anterior body displacement
mechanically stable
what sign is associated with a unilateral facet dislocation?
bow tie sign
what are the radiographic features of a unilateral facet dislocation
abrupt dereased laminar length
spinous rotation to the side of dislocation
what xrays should be taken if you suspect a unilateral facet dislocation?
cervical obliques
bilateral facet dislocation
hyperflexion mechanism of C4-7 MC
severe soft tissue injury
unstable, high incidence of cord injuries
anterior dislacement typically
ppathological fracture
decreased height of the entire body implies pathology MC osteoporosis also lytic mets, multiple myeloma proper workup needed
burst fractures in thoracics of lumbars
widened intrapedicular distance CT exam needed vertebral body "explodes axial compression mechanism may have post. body convexity
widened intrapedicular disttance means there is?
neural arch fx or posterior wall fracture
chance fracture
horizontal splitting of neural arch and vertebral body
flexion distraction mechanism
seatbelt acts as a fulcrum
MC L1-3
what signs do we see with chance fractures?
empty vertebra sign
ghost vertebra sign
findings we can see with chance fracture
decreased anterior body height
step defect
zone of impaction
horizontal radiolucent line in neural arch
TVP fracture
2nd most common lumbar fx direct trauma or avulsion MC L2 or 3 vertical to oblique in orientation often unilateral and often milti level may or may not be displaced
what can TVP fractures be obscured by?
gas and fecal material
what else do you need to do with TVP fractures?
uninalysis for potential hematuria b/c the kidney could be damaged
sponlylolysis
interruption of the parts
spondylolisthesis
anterior displacement
osteoporotic compression fractures general features
more common after 50 females MC mid thoracolumbar spine dowager's hump resorption of horizontal trabeulae accentuated vertical striations
osteoporotic compression fractures xray features
decreased anterior body height
multiple ones are often contiguous
discontiguous raises concerns
potential pathology, special imaging
most thoracic and lumbar fractures are MC where?
T11-L2
contiguous fractures are uncommon or common?
common
what kind of thoracic and lumbar fractures are most common?
compression fracture
thoracolumbar compression fractures
osteoporotic fx may have no trauma
upper thoracic compression may result from seizures or electrical shock
what are some xray features of thoracolumbar compression fractures
anterior wedging
depression of superior endplate
posterior body height usually maintained
may see step defect and zone of impaction
what is whiplash?
soft tissue injury (flexion component)
disruption of posterior ligament complex
abrupt kyphotic spine
pain, tenderness, muscle spasm
what are the xray features of whiplash?
widened interspinous spaces (fanning)
subluxated widened facets (loss of parallelism)
flexion and extension views to stress ligaments
flexion malposition
high riding facets (NOT perched)
uncinate fractures
rare
stable
lateral flexion
lateral flexion
unilateral fx of the lateral mass of C1
TVP fx
uncinate fx
pillar fractures
not common fx commonly missed seen on AP and lateral MC C4-7 extension-compression mechanism
laminar fractures
uncomon hyperextension lower cervicals may been CT mechanically stable
spinous fractures
mid cervical, thoracic (NOT T1) or lumbar
clay shoveler’s fx is what kind of mechanism?
flexion
clay shoveler’s fx
fracture at the base of the spinous of C6-T1 only
avulsion fracture
stable
what are the xray signs of clay shoveler’s fx?
fracture at base of spinous
double spinous sign on AP
may or may not be displaced inferior
jagged, irregular radiolucency (new)
extension teardrop fx
extension mechanism
triangular fragment of anterior-inferior body
usualy C2
unstable
buckling of ligamentum flavum (cord trauma)
flexion teardrop fx
most severe injury of cervical spine triangular fragment at the anterior inferior body unstable, acute "anterior cord syndrome" flexion mechanism facets "subluxated or dislocated" typically spine considerably flexed
bilateral facet dislocation
hyperflexion mechanism (C4-7)
severe soft tissue injury
unstable, high incidence of cord injuries
anterior displacement
perched facets
incomplete bilateral facet dislocation
interlocking facets
complete bilateral facet dislocation
unilateral facet dislocation
pillars not superimposed (bowtie sign) abrupt decreased laminar length spinous rotation to the side of dislocation cervical obliques should be done flexion rotation mechanism inferior articular process dislocates into IVF anterior body displacement stable
burst fracture
vertebral body "explodes" into several fragments fragments are driven centrifugally axial compression forces predominate pssible cord compression unstable may see vertical split of the body on AP lateral shows comminuted body flattened centrally neurological involvement is variable
describe ischiopubic rami fractures
stable
most common fracture of the pelvis
stress fx may occur
what part is most commonly fractured in ischiopubic rami fractures?
inferior rami, but superior rami can take part as well
who are more likley to get avulsion fractures of the pelvis?
athletic adolescents
sprinters, long jumpers, hurdlers, gymnasts
what leads to an avulsion fracture?
muscular traction
what kind of avulsions are avulsion fractures of the pelvis?
apophyseal avulsion
what muscle cause an avulsion fracture of the ASIS?
sartorius
what muscle causes an avulsion fracture of the AIIS?
rectus femoris
what muscle causes an avulsion fracture of the ischial tuberosity?
hamstring
where do you most commonly get avulsion fx of the pelvis?
ischial tuberosity
what are some radiographic signs and treatments for avulsion fractures of the pelvis?
curvilinear calcific densities
from conservative to surgical fixation
could unite, or not
may have enlgargement with healing
malgaingne fracture
ipsilateral double vertical shearing fx of superior and inferior pubic rami with fx or dislocation about ipsilateral SI joint
what is the most common unstable pelvic fx?
malgaingne fx
bucket-handle fracture
contralateral double vertical fx
superior and inferior pubic rami fx
fx or dislocation about contralateral SI
unstable
straddle fracture
bilateral superior and inferior rami fx
substantial soft tissue injury
unstable
sprung pelvis
“open book” fx
diastasis of pubic symphysis
diastasis of one or both SI joints
unstable
complex pelvic fractures
unstable severe injury comminution of the pelvis difficult to classify complex multiple fx
if an adult has an avulsion fracture of the lesser trochanter, what does this mean?
it’s probably lytic mets
