Razi Trauma Review Flashcards
Define instability:
- translation of 3.5mm (or 20%)
- angulation >10 degrees
- direct MRI visualization of a disrupted discoligamentous complex (PLC/DLC)
What did STASCIS study show:
decompression within 24 hours is safe and is a predictor of improved neurologic outcome
- includes central cord syndrome
SLIC Classification
- morphology
- discoligamentous copmlex
- neurological status
score >5 requires surgery
Timing to closed reduction of facet dislocations:
- within 1-3 hours if you have neurologic defecits
Clay Shoveler Fracture
spinous process avulsion
Sentinel fracture
laminar fx on either side of the SP
Vertebral artery injuries
occur in 11% of c-spine injuries most commonly with lateral mass fracture
Hangman is:
bilateral C2 pars fracture
Pseudosubluxation:
C3-4 in kids under age 4
due to horizontal facets
C2 fx, type 2, greater than 5mm displacement requires:
fusion
if <5mm they can have a halo
parameters for halo placement
- 4 pins, 8lb
- ## peds = more pins, less lbs
non op treatment for type 3 dens fx is:
hard collar
AAOS guidelines for compression fx:
- give calcitonin within 4 days
- bracing is not indicated, other than for comfort…
- vertebroplasty is never indicated (According to guidelines)
- kyphoplasty (if still painful after 6 weeks of non-op… the indication is persistent pain)
- L2 nerve root block is indicated for L3 of L4 injuries
when do you do surgery for burst fracture:
50% canal compromise
OR 10 degrees angulation
treatment for chance fracture:
bony chance = non op
ligamentous = op
associated injuries with chance fracture
visceral injuries
- mesenteric artery rupture
- sigmoid colon
fusion levels for TL injuries?
3 above and 2 below
TLICS score for surgery?
5 or greater
where do the iliac vessels bifurcate
L4-5 and body of L5
lumbar total disc at 2 years has:
better patient satisfaction than fusion
no difference in revision or complication
SPORT:
improvement in primary and secondary outcomes with surgery compared with non-op at 4 years, 8 years
best improvement with:
- back pain
- upper lumbar HNP
- married
- worsening pain
at 8 years, 85% of reop due to recurrent HNP
steroid dose
30mg/kg loading for first hour, then 5mg/kg/hr x23 hours if given within 3 hours (or x47 hours if given >3 hours)
if you see a facet cyst it suggests:
instability
- get flex/ex
- may be more likely to require fusion
what is hanging curtain sign
the psoas moves upward from a spinal abscess - it is draped over the abscess
anytime you do a decompression for infection in the thoracic spine what do you do:
- need to fuse them because of the thoracic kyphosis
- if you do lami, with the loss of disc and bone, you are high risk for progressive kyphosis
hemangiomas on MRI are:
bright on T1 and T2
most common root in a degen spndy?
L5
isthmic spondy most commonly occurs at:
L5 (fuse L5-S1 if unremitting)
in situ fusion is:
posterolateral fusion without instrumentation, with bone grafting
retrograde ejaculation from:
superior hypogastric plexus injury
pediatric rotatory subluxation treatment
if chronic, needs C1-2 fusion if <1 week, do soft collar and nsaids if >1 week is head halter traction and muscle relaxants >1 month is halo traction >6 months is fusion
most common cause is Grisel’s syndrome (URI)
dx on xrays and dynamic CT scan
fails to resolve with attempts to correct the torticollis
C spine issue in OI
basilar invagination
C spine issue in Morquio
AA instability
