Spinal Fracture Flashcards

1
Q

Classification of Spinal Fractures (1,2,3)

A

1 - stable
2 - unstable
3 - unstable, lot of displacement

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2
Q

What parts of the spine are most commonly injured?

A

Lower Cervical Spine and Thoracolumbar junction

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3
Q

Stability

A

immediate or subsequent risk of spinal cord and spinal nerve root injury

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4
Q

Stable injuries

A
  1. do not have significant bone or joint displacement

2. ligamentous structures remain intact

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5
Q

Unstable injuries

A

show or have potential for significant displacement

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6
Q

Fractures involving 1 column are _____?

A

Stable

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7
Q

Fractures involving 3 columns are _______?

A

Unstable

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8
Q

High mortality rate above what vertebra?

A

C4 - control of respiratory fxn.

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9
Q

Treatment of C-Spine Injury

A

Immobilization, Ongoing neurological examination, Imaging, Stabilization

Conservative Stabilization - Closed reduction, traction, bracing

Surgical Stabilization - Decompression, Posterior/Anterior fusion

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10
Q

Occipital Condyle Fractures

A

Rare
Type 1 and 2 - cervical orthosis or halo
Type 3 - cervical orthosis or Halo; Occ-C2 PSF if unstable

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11
Q

Atlanto-Occipital Dislocation (AOD)

A
  • Rare (few survive)
  • Associated with spinal cord involvement
  • Careful immobilization and reduction with positioning and halo
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12
Q

Atlas (Jefferson) Fracture

A

Usually due to axial loading of the occiput (compressive force)
-“Burst” fracture
Rarely associated with neurologic injury

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13
Q

C2 (Odontoid) Fracture

A
  • Bimodal distribution of incidence (risky behavior or osteoporosis)
  • High non-union rates
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14
Q

Non-union def.

A

does not heal

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15
Q

Occipital-Cervical Injuries (Type 1,2,3)

A

1 - Cervical orthosis
2 - Immediate halo or Traction and PSF
3 - Immediate halo or Traction AND halo

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16
Q

C2 (Axis) Fracture

A

“Hangman’s Fracture”
Traumatic hyperextension causes bilateral pars interarticularis fractures

Common in car accidents

17
Q

C2 Fracture can lead to _____

A

neuro compromise

18
Q

Subaxial Cervical Injuries

A
  1. Lower C-spine injury is ASSUMED until proven otherwise

2. Managed with anterior decompression/fusion

19
Q

Distraction-Flexion Injury

A
  1. Distraction load on a flexed neck
  2. Common in MVA, sports
  3. Mainly b/w C5-C7
20
Q

Unilateral facet dislocation is also know as:

A

“Bowtie” sign

Shift of spinous processes at the level of injury

21
Q

Surgeries for subaxial cervical injuries

A
  1. Immediate closed reduction
  2. Posterior stabilization
  3. Anterior decompression and stabilization if herniated disc
22
Q

Vertical Compression Injury

A
  1. MVA or diving most common
  2. C5-7 most vulnerable
  3. Compresses and shortens anterior and middle columns
23
Q

Compression-Flexion Injury

A
  1. “Tear drop” fracture

2. Accompanied by compromised stability

24
Q

Lateral Flexion Injury

A
  1. MVA, blow to the head

2. Rarely involve ligamentous injury requiring surgical stabilization

25
Thoracic Spine Fractures
1. T12 and T1 are injured most often 2. Compression, metastatic disease, trauma 3. Flexion force usually contributes to injury
26
Thoracic Spine Fractures - Compressive
Failure of anterior column, low risk of neurologic compromise (Osteoporosis)
27
Thoracic Spine Fractures - Burst
Result of axial loading, often associated with neurologic compromise
28
Thoracic Spine Fractures - Flexion Distraction (seatbelt)
Transverse fracture line, rather rare
29
Thoracic Spine Fractures - Dislocation
Considered unstable, often involving failure of all 3 columns and transverse process fracture or costal articulation
30
Lumbar Spine Fractures (LSF)
1. T11-L2 is most common 2. Hyperflexion w/ or w/o shear, rotation, and axial compression are most common mechanisms 3. Associated with hindfoot and burst fractures
31
LSF - T11-L2
Susceptible to injury and instability
32
LSF - L2-L5
Structure size and protective musculature stabilize joint
33
LSF - L5-S1
Unstable, largely due to force necessary to cause injury
34
Most common post surgical stabilization?
Immobilization
35
What to focus on post fracture/fusion?
1. Mobility rather than strengthening specific back musculature 2. Logrolling 3. Avoid flexion and rotation in ADL's
36
When does scoliosis call for surgery?
If curvature is > 40-50 percent