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AIP: Trauma > Spinal fracture > Flashcards

Spinal fracture Flashcards

1
Q

What are the 3 anatomical regions in which spinal fractures should be considered?

A
  1. Cervical
  2. Thoracic
  3. Lumbar
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2
Q

With one spinal fracture following trauma, what is the percentage chance of a second fracture elsewhere in the spine?

A

10-20%

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3
Q

What should be your initial general management due to the high risk of a second fracture if one spinal fracture is identified?

A

actively seek out second fracture, keep the whole spine immobilised until excluded

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4
Q

What are 6 types of traumatic cervical fractures and dislocations?

A
  1. Flexion-rotation injuries
  2. Facet joint dislocations
  3. C1 (Jefferson) fracture
  4. Odontoid peg fractures
  5. Hangman’s fractures
  6. C3 to C7 fractures
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5
Q

What are 2 types of flexion-rotation injuries to the cervical spine?

A

stable or unstable

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6
Q

What type of damage can flexion-rotation injuries cause to the cervical spine?

A

may produce fractures and/or dislocations

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7
Q

What are 3 examples of types of injuries caused by flexion-rotation injuries to the cervical spine?

A
  1. Anterior wedge fractures
  2. Unilateral and bilateral facet joint dislocation
  3. Avulsion of spinous processes
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8
Q

What type of injury is a facet joint dislocation in the cervical spine?

A

major and unstable injuries, with either impending or established spinal cord injury

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9
Q

What is a spinal facet joint?

A

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

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10
Q

What is the immediate management of facet joint dislocations?

A

immobilise fully and minimise movement

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11
Q

What is the key investigaiton to perform for suspected facet joint dislocations?

A

urgent CT scan

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12
Q

What is the management of facet joint dislocations?

A
  • 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
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13
Q

What is the classic fracture pattern of a C1 (Jefferson) fracture?

A

quadripartite fracture, where there is axial loading and thus a ‘burst’ fracture

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14
Q

What are 3 aspects of the management of C1 (Jefferson) fractures?

A
  1. CT scan
  2. Spinal surgeon opinion
  3. Immobilise with halo brace
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15
Q

What is the risk of gross disruption of the ring of C1 in C1 (Jefferson) fractures?

A

it may be unstable and cause immediate death

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16
Q

What are 2 ways that odontoid peg fractures can occur?

A
  1. Peg fractured directly
  2. Peg may become unstable when its restraining transverse ligament is disrupted (treat with immobilisation adn urgent traction)
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17
Q

How should an odontoid peg fracture caused by its restraining transverse ligament beign disrupted be managed?

A

immobilisation and urgent traction

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18
Q

What are the 3 types of odontoid peg fractures?

A
  1. Type 1: tip of the peg
  2. Type 2: junction of head and body
  3. Type 3: below the junction of head and body
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19
Q

What is the most common type of odontoid peg fracture?

A

type 2: junction of head and body

20
Q

Is a type I (tip of peg) odontoid fracture stable or unstable?

A

stable

21
Q

Is a type II (junction of head and body) odontoid fracture stable or unstable?

A

unstable

22
Q

Is a type III (below junction of head and body) odontoid fracture stable or unstable?

A

unstable

23
Q

How common are type I (tip of peg) odontoid peg fractures and what is the prognosis?

A

rare, good prognosis

24
Q

What is the management of type I odontoid peg fractures (tip of peg)?

A

treat with collar

25
Q

What is a Hangman’s fracture of the cervical spine?

A

hyperextension injury with fracture of pedicles of C2

may be disruption of C2-C3 junction

26
Q

What are 4 aspects of the immediate management of Hangman’s fractures?

A
  1. Immobilise
  2. Call seniors early on
  3. Arrange CT scan
  4. Discuss with spinal surgeons
27
Q

What are 2 definitive treatment options for Hangman’s fractures?

A
  1. Skull traction for 6 weeks
  2. Surgical fixation
28
Q

What does the stability/ instability of C3 to C7 fractures depend on?

A

the fracture configuration

29
Q

What are 3 overarching aspects of the management of all C3 to C7 fractures?

A
  1. Immobilise
  2. Obtain Ct
  3. Discuss with spinal surgeons
30
Q

What does the cervical spine x-ray show?

A

white line indicates disruption of anterior spinal line; C5 vertebrae displaced by 50% compared with C6, indicating bifacet dislocation

31
Q

What is a common type of thoracic/lumbar spine fracture following falls?

A

wedge fractures

32
Q

Are most wedge fractures stable or unstable?

A

most are stable (anterior column only)

33
Q

What is the management of wedge fractures of the spine?

A

bed rest and analgesia until acute pain resolves, followed by gradual and controlled mobilisation

34
Q

What are 2 examples of types of spinal fractures involving 2 or 3 columns?

A
  1. Burst fractures
  2. Dislocations
35
Q

What is meant by a burst fracture of the spine?

A

compression fracture in which vertebra is crushed in all directions, due to high-energy axial loading spinal trauma

36
Q

What is the management of spinal fractures involving two or three columns?

A

should be immobilised on spinal bed and spinal surgeon advice sought

37
Q

What is a Chance fracture of the spine?

A

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

38
Q

At what position do Chance fractures most commonly occur?

A

thoraco-lumbar junction (T12-L2)

39
Q

What type of injury causes Chance fractures?

A

violent forward flexion - typically after restraint from a head-on impact whilst wearing a lap belt

40
Q

What key type of injury are Chance fractures associated with?

A

intra-abdominal inujries

41
Q

What sign will be evident with Chance fractures involving bone (rather than purely ligamentous injury)?

A

owl’s eye sign

42
Q

What is the treatment of Chance fractures based upon?

A

may be operatively or non-operatively based on pattern/stability

43
Q

What investigation should be considered for Chance fractures?

A

CT

44
Q

Why are fractures at the thoraco-lumbar junction commonly missed? 3 reasons

A
  1. due to failure to appreciate the mechansim of inury e.g. ejection from a car
  2. major distracting injury
  3. concentrating on the cervical spine
45
Q

In older patients, what type of spinal fracture should be considered if one is identified?

A

pathological fractures

46
Q

What type of fractures are fractures of the sacrum and coccyx considered to be?

A

part of a pelvic fracture

AIP: Trauma (20 decks)

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