Spinal fracture Flashcards
What are the 3 anatomical regions in which spinal fractures should be considered?
- Cervical
- Thoracic
- Lumbar
With one spinal fracture following trauma, what is the percentage chance of a second fracture elsewhere in the spine?
10-20%
What should be your initial general management due to the high risk of a second fracture if one spinal fracture is identified?
actively seek out second fracture, keep the whole spine immobilised until excluded
What are 6 types of traumatic cervical fractures and dislocations?
- Flexion-rotation injuries
- Facet joint dislocations
- C1 (Jefferson) fracture
- Odontoid peg fractures
- Hangman’s fractures
- C3 to C7 fractures
What are 2 types of flexion-rotation injuries to the cervical spine?
stable or unstable
What type of damage can flexion-rotation injuries cause to the cervical spine?
may produce fractures and/or dislocations
What are 3 examples of types of injuries caused by flexion-rotation injuries to the cervical spine?
- Anterior wedge fractures
- Unilateral and bilateral facet joint dislocation
- Avulsion of spinous processes
What type of injury is a facet joint dislocation in the cervical spine?
major and unstable injuries, with either impending or established spinal cord injury
What is a spinal facet joint?
The joint in between the articular facet on the superior process of the vertebra below with the articular facet on the inferior articular process of the vertebra above
What is the immediate management of facet joint dislocations?
immobilise fully and minimise movement
What is the key investigaiton to perform for suspected facet joint dislocations?
urgent CT scan
What is the management of facet joint dislocations?
- Immobilise fully and minimise movement
- Halo brace may be needed following reduction
- OR surgical reduction and stabilisation
- seek senior help early, discuss with spinal surgeons
What is the classic fracture pattern of a C1 (Jefferson) fracture?
quadripartite fracture, where there is axial loading and thus a ‘burst’ fracture
What are 3 aspects of the management of C1 (Jefferson) fractures?
- CT scan
- Spinal surgeon opinion
- Immobilise with halo brace
What is the risk of gross disruption of the ring of C1 in C1 (Jefferson) fractures?
it may be unstable and cause immediate death
What are 2 ways that odontoid peg fractures can occur?
- Peg fractured directly
- Peg may become unstable when its restraining transverse ligament is disrupted (treat with immobilisation adn urgent traction)
How should an odontoid peg fracture caused by its restraining transverse ligament beign disrupted be managed?
immobilisation and urgent traction
What are the 3 types of odontoid peg fractures?
- Type 1: tip of the peg
- Type 2: junction of head and body
- Type 3: below the junction of head and body
What is the most common type of odontoid peg fracture?
type 2: junction of head and body
Is a type I (tip of peg) odontoid fracture stable or unstable?
stable
Is a type II (junction of head and body) odontoid fracture stable or unstable?
unstable
Is a type III (below junction of head and body) odontoid fracture stable or unstable?
unstable
How common are type I (tip of peg) odontoid peg fractures and what is the prognosis?
rare, good prognosis
What is the management of type I odontoid peg fractures (tip of peg)?
treat with collar
What is a Hangman’s fracture of the cervical spine?
hyperextension injury with fracture of pedicles of C2
may be disruption of C2-C3 junction
What are 4 aspects of the immediate management of Hangman’s fractures?
- Immobilise
- Call seniors early on
- Arrange CT scan
- Discuss with spinal surgeons
What are 2 definitive treatment options for Hangman’s fractures?
- Skull traction for 6 weeks
- Surgical fixation
What does the stability/ instability of C3 to C7 fractures depend on?
the fracture configuration
What are 3 overarching aspects of the management of all C3 to C7 fractures?
- Immobilise
- Obtain Ct
- Discuss with spinal surgeons
What does the cervical spine x-ray show?
white line indicates disruption of anterior spinal line; C5 vertebrae displaced by 50% compared with C6, indicating bifacet dislocation
What is a common type of thoracic/lumbar spine fracture following falls?
wedge fractures
Are most wedge fractures stable or unstable?
most are stable (anterior column only)
What is the management of wedge fractures of the spine?
bed rest and analgesia until acute pain resolves, followed by gradual and controlled mobilisation
What are 2 examples of types of spinal fractures involving 2 or 3 columns?
- Burst fractures
- Dislocations
What is meant by a burst fracture of the spine?
compression fracture in which vertebra is crushed in all directions, due to high-energy axial loading spinal trauma
What is the management of spinal fractures involving two or three columns?
should be immobilised on spinal bed and spinal surgeon advice sought
What is a Chance fracture of the spine?
flexion-distraction type injuries of spine that extend to involve all three spinal columns (aka seat belt fractures - common cause)
horizontal fracture extending from posterior to anterior through the spinous process, pedicles, and vertebral body
At what position do Chance fractures most commonly occur?
thoraco-lumbar junction (T12-L2)
What type of injury causes Chance fractures?
violent forward flexion - typically after restraint from a head-on impact whilst wearing a lap belt
What key type of injury are Chance fractures associated with?
intra-abdominal inujries
What sign will be evident with Chance fractures involving bone (rather than purely ligamentous injury)?
owl’s eye sign
What is the treatment of Chance fractures based upon?
may be operatively or non-operatively based on pattern/stability
What investigation should be considered for Chance fractures?
CT
Why are fractures at the thoraco-lumbar junction commonly missed? 3 reasons
- due to failure to appreciate the mechansim of inury e.g. ejection from a car
- major distracting injury
- concentrating on the cervical spine
In older patients, what type of spinal fracture should be considered if one is identified?
pathological fractures
What type of fractures are fractures of the sacrum and coccyx considered to be?
part of a pelvic fracture
