Spinal Fracture

Question 1

Classification of Spinal Fractures (1,2,3)

Answer 1

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

Question 2

What parts of the spine are most commonly injured?

Answer 2

Lower Cervical Spine and Thoracolumbar junction

Question 3

Stability

Answer 3

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

Question 4

Stable injuries

Answer 4

1. do not have significant bone or joint displacement

2. ligamentous structures remain intact

Question 5

Unstable injuries

Answer 5

show or have potential for significant displacement

Question 6

Fractures involving 1 column are _____?

Answer 6

Stable

Question 7

Fractures involving 3 columns are _______?

Answer 7

Unstable

Question 8

High mortality rate above what vertebra?

Answer 8

C4 - control of respiratory fxn.

Question 9

Treatment of C-Spine Injury

Answer 9

Immobilization, Ongoing neurological examination, Imaging, Stabilization

Conservative Stabilization - Closed reduction, traction, bracing

Surgical Stabilization - Decompression, Posterior/Anterior fusion

Question 10

Occipital Condyle Fractures

Answer 10

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

Question 11

Atlanto-Occipital Dislocation (AOD)

Answer 11

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

Question 12

Atlas (Jefferson) Fracture

Answer 12

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

Question 13

C2 (Odontoid) Fracture

Answer 13

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

Question 14

Non-union def.

Answer 14

does not heal

Question 15

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

Answer 15

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

Question 16

C2 (Axis) Fracture

Answer 16

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

Common in car accidents

Question 17

C2 Fracture can lead to _____

Answer 17

neuro compromise

Question 18

Subaxial Cervical Injuries

Answer 18

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

2. Managed with anterior decompression/fusion

Question 19

Distraction-Flexion Injury

Answer 19

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

Question 20

Unilateral facet dislocation is also know as:

Answer 20

“Bowtie” sign

Shift of spinous processes at the level of injury

Question 21

Surgeries for subaxial cervical injuries

Answer 21

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

Question 22

Vertical Compression Injury

Answer 22

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

Question 23

Compression-Flexion Injury

Answer 23

1. “Tear drop” fracture

2. Accompanied by compromised stability

Question 24

Lateral Flexion Injury

Answer 24

1. MVA, blow to the head

2. Rarely involve ligamentous injury requiring surgical stabilization

Question 25

Thoracic Spine Fractures

Answer 25

1. T12 and T1 are injured most often
2. Compression, metastatic disease, trauma
3. Flexion force usually contributes to injury

Question 26

Thoracic Spine Fractures - Compressive

Answer 26

Failure of anterior column, low risk of neurologic compromise (Osteoporosis)

Question 27

Thoracic Spine Fractures - Burst

Answer 27

Result of axial loading, often associated with neurologic compromise

Question 28

Thoracic Spine Fractures - Flexion Distraction (seatbelt)

Answer 28

Transverse fracture line, rather rare

Question 29

Thoracic Spine Fractures - Dislocation

Answer 29

Considered unstable, often involving failure of all 3 columns and transverse process fracture or costal articulation

Question 30

Lumbar Spine Fractures (LSF)

Answer 30

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

Question 31

LSF - T11-L2

Answer 31

Susceptible to injury and instability

Question 32

LSF - L2-L5

Answer 32

Structure size and protective musculature stabilize joint

Question 33

LSF - L5-S1

Answer 33

Unstable, largely due to force necessary to cause injury

Question 34

Most common post surgical stabilization?

Answer 34

Immobilization

Question 35

What to focus on post fracture/fusion?

Answer 35

1. Mobility rather than strengthening specific back musculature
2. Logrolling
3. Avoid flexion and rotation in ADL’s

Question 36

When does scoliosis call for surgery?

Answer 36

If curvature is > 40-50 percent