Spinal Fracture Flashcards
Classification of Spinal Fractures (1,2,3)
1 - stable
2 - unstable
3 - unstable, lot of displacement
What parts of the spine are most commonly injured?
Lower Cervical Spine and Thoracolumbar junction
Stability
immediate or subsequent risk of spinal cord and spinal nerve root injury
Stable injuries
- do not have significant bone or joint displacement
2. ligamentous structures remain intact
Unstable injuries
show or have potential for significant displacement
Fractures involving 1 column are _____?
Stable
Fractures involving 3 columns are _______?
Unstable
High mortality rate above what vertebra?
C4 - control of respiratory fxn.
Treatment of C-Spine Injury
Immobilization, Ongoing neurological examination, Imaging, Stabilization
Conservative Stabilization - Closed reduction, traction, bracing
Surgical Stabilization - Decompression, Posterior/Anterior fusion
Occipital Condyle Fractures
Rare
Type 1 and 2 - cervical orthosis or halo
Type 3 - cervical orthosis or Halo; Occ-C2 PSF if unstable
Atlanto-Occipital Dislocation (AOD)
- Rare (few survive)
- Associated with spinal cord involvement
- Careful immobilization and reduction with positioning and halo
Atlas (Jefferson) Fracture
Usually due to axial loading of the occiput (compressive force)
-“Burst” fracture
Rarely associated with neurologic injury
C2 (Odontoid) Fracture
- Bimodal distribution of incidence (risky behavior or osteoporosis)
- High non-union rates
Non-union def.
does not heal
Occipital-Cervical Injuries (Type 1,2,3)
1 - Cervical orthosis
2 - Immediate halo or Traction and PSF
3 - Immediate halo or Traction AND halo
C2 (Axis) Fracture
“Hangman’s Fracture”
Traumatic hyperextension causes bilateral pars interarticularis fractures
Common in car accidents
C2 Fracture can lead to _____
neuro compromise
Subaxial Cervical Injuries
- Lower C-spine injury is ASSUMED until proven otherwise
2. Managed with anterior decompression/fusion
Distraction-Flexion Injury
- Distraction load on a flexed neck
- Common in MVA, sports
- Mainly b/w C5-C7
Unilateral facet dislocation is also know as:
“Bowtie” sign
Shift of spinous processes at the level of injury
Surgeries for subaxial cervical injuries
- Immediate closed reduction
- Posterior stabilization
- Anterior decompression and stabilization if herniated disc
Vertical Compression Injury
- MVA or diving most common
- C5-7 most vulnerable
- Compresses and shortens anterior and middle columns
Compression-Flexion Injury
- “Tear drop” fracture
2. Accompanied by compromised stability
Lateral Flexion Injury
- MVA, blow to the head
2. Rarely involve ligamentous injury requiring surgical stabilization
Thoracic Spine Fractures
- T12 and T1 are injured most often
- Compression, metastatic disease, trauma
- Flexion force usually contributes to injury
Thoracic Spine Fractures - Compressive
Failure of anterior column, low risk of neurologic compromise (Osteoporosis)
Thoracic Spine Fractures - Burst
Result of axial loading, often associated with neurologic compromise
Thoracic Spine Fractures - Flexion Distraction (seatbelt)
Transverse fracture line, rather rare
Thoracic Spine Fractures - Dislocation
Considered unstable, often involving failure of all 3 columns and transverse process fracture or costal articulation
Lumbar Spine Fractures (LSF)
- T11-L2 is most common
- Hyperflexion w/ or w/o shear, rotation, and axial compression are most common mechanisms
- Associated with hindfoot and burst fractures
LSF - T11-L2
Susceptible to injury and instability
LSF - L2-L5
Structure size and protective musculature stabilize joint
LSF - L5-S1
Unstable, largely due to force necessary to cause injury
Most common post surgical stabilization?
Immobilization
What to focus on post fracture/fusion?
- Mobility rather than strengthening specific back musculature
- Logrolling
- Avoid flexion and rotation in ADL’s
When does scoliosis call for surgery?
If curvature is > 40-50 percent
