Skull Fractures and Spinal Trauma

Question 1

What is the most common type of a skull fracture?

Answer 1

Linear skull fractures

Question 2

What area is destroyed by a “blowout” fracture?

Answer 2

Inferior orbit (therefore leading to blood in the maxillary sinus)

Question 3

In what plane is a CT administered?

Answer 3

Axial

Question 4

A tripod fracture involves what anatomy?

Answer 4

All three attachments of the zygomatic bone to the face (zygomaticomaxillary complex)

Question 5

What is the name of the fracture acquired in facial trauma e the maxillary bone and surrounding structures usually in a bilateral and either horizontal, pyramidal, or transverse way?

Answer 5

LeFort

Question 6

What are the three types of LeFort fractures?

Answer 6

Type 1 = horizontal (nose only)
Type 2 = pyramidal (nose and teeth)
Type 3 = transverse (whole face)

Question 7

Between what structures do subdural hematomas form?

Answer 7

Between the dura mater and brain

Question 8

Are subdural hematomas usually concave or convex?

Answer 8

Convex

Question 9

Which has a better prognosis: acute or chronic subdural hematomas?

Answer 9

Chronic (when properly managed)

Question 10

What type of injury is the result when the damage is seen on the side opposite of the trauma?

Answer 10

Contra coup

Question 11

What type of cranial hematoma is concave in shape?

Answer 11

Epidural or extradural (remember that subdural ones are conVEX)

Question 12

What type of imaging should be done when a patient presents with signs and symptoms of a skull fracture?

Answer 12

Head CT

Question 13

What mechanism of injury is the most common force to cause spinal trauma?

Answer 13

Flexion (hyperflexion most common to cause spinal trauma)

Question 14

What is the most damaging injury to the cervical spine?

Answer 14

Flexion teardrop fracture (NOT EXTENSION)

Question 15

What is the name for a spinous process fracture in the cervical spine?

Answer 15

Clay shoveler’s fracture

Question 16

What is the most common fracture to occur due to a hyperflexion injury?

Answer 16

Simple wedge (compression) fracture

Question 17

What kind of injury occurs due to hyperflexion and rotation?

Answer 17

Unilateral interfacetal dislocation and/or fracture

Question 18

Is a teardrop fracture “better” to get with hyperflexion or hyperextension?

Answer 18

Hyperextension

Question 19

In today’s society, what situation can cause a hangman’s fracture?

Answer 19

MVA

Question 20

Are Hangman’s fractures associated with hyperflexion or hyperextension?

Answer 20

Hyperextension

Question 21

What kinds of anatomical fractures are seen with hyperextension-rotation injuries?

Answer 21

Pillar fractures or pedicolaminar fractures

Question 22

What is another name for a Jefferson’s fracture of C1?

Answer 22

Burst fracture

Question 23

How many fractures occur with Jefferson’s fracture?

Answer 23

4

Question 24

What are the most common areas for spinal trauma?

Answer 24

C1-C2, C5-C7, T12-L1

Question 25

Why is T12-L1 a vulnerable area for fractures?

Answer 25

1 no articulating ribs to the sternum for protection
2 skinny psoas muscle attachment at top compared to bottom
3 transitional zone

Question 26

What is the Davis Series for?

Answer 26

7 view cervical spine series to check for fractures

Question 27

What are the 7 views of the Davis series in order from first to last?

Answer 27

Lateral, APOM, AP cervical, left and right obliques, flexion/extension, “swimmers”

Question 28

Which view is done first in the Davis Series and why?

Answer 28

Lateral view - every other view requires movement by the patient which can be potentially dangerous if a fracture is present

Question 29

The segment is considered unstable if which specific column of the vertebra is disrupted?

Answer 29

Middle

Question 30

Which ligament is particularly at risk with a middle column disruption of a segment?

Answer 30

Posterior longitudinal ligament

Question 31

What four things can contribute to increased soft tissue swelling seen near the cervical spine?

Answer 31

Edema, blood, pus, tumors

Question 32

What are the normal limits for the retropharyngeal space?

Answer 32

No more than 7mm at C2, no more than 5mm at C3/C4

Question 33

What is the normal limit for the retrotracheal space?

Answer 33

No more than 22mm in adults, no more than 14mm in children younger than 15 years of age (found at C6)

Question 34

What can cause a displaced prevertebral fat stripe?

Answer 34

SOL

Question 35

On what view do we see the tracheal air shadows?

Answer 35

AP cervical

Question 36

What contour lines are used to assess vertebral alignment?

Answer 36

Anterior vertebral line, posterior vertebral line, spinolaminar line (and also posterior spinous line)

Question 37

What signs are seen with spinal trauma that are indicative of abnormal joints?

Answer 37

Increased ADI, abnormal disc height, widened apophyseal joints

Question 38

What are the maximum ADI measurements for both adults and children?

Answer 38

Adults = 3mm
Children = 5mm

Question 39

What measurement of horizontal body displacement is considered to be unstable?

Answer 39

Greater than 3.5mm

Question 40

What measurement of vertebral flexion is indicative of spinal trauma when compared to the rest?

Answer 40

Greater than 11 degrees of flexion

Question 41

A vacuum cleft disc is indicative of what overlying condition?

Answer 41

DJD

Question 42

How long does it take for spinal fractures to heal?

Answer 42

3-6 months (slow healing…much slower than extremities)

Question 43

Do body fractures or arch fractures heal more with fibrosis? Which heal more with callus?

Answer 43

Body fractures - fibrosis

Arch fractures - callus