Spinal Fractures Flashcards
Spine Fracture Classifications (3)
I - Stable
II - Unstable
III - Unstable
Fracture Management Areas (5)
- Fracture stability
- Fracture alignment
- Neurological involvement
- Age
- Patient compliance w/ interventions
What are the most common spinal injuries?
- C-spine (2/3)
- T-L region
- 40% associated with neurological involvement
Anterior Spinal Column
Anterior longitudinal ligament through 2/3 of vertebral body/annulus fibrosis
Middle Column
Posterior 1/3 of vertebral body/annulus fibrosis to posterior longitudinal ligament
Posterior Column
Posterior longitudinal ligament through remaining vertebral arch structures
Stable Spinal Fractures
- Patient does not have significant joint displacement and no neurological involvement.
- Ligaments usually remain intact
- Examples - compression fractures, disc herniations, unilateral facet dislocation
Unstable Spinal Fractures
- Patient is at high risk for neurological involvement due to significant displacement of fracture
- Examples - fracture dislocations, bilateral facet dislocations
Spinal Stability
Amount of risk of spinal cord or spinal nerve root damage
- 1 column = stable
- 3 columns = unstable
- 2 columns follows middle column
Cervical Fracture Causes (2)
- Usually caused by MVA, violence, and sports
- Usually avulsive, compression or impaction related injuries
Cervical Fracture Categories (2)
- Occipital-cervical (occipital bone, C1, C2)
- Subaxial (C3-C7)
Why is a fracture at C4 and above the most dangerous?
Will cause respiratory function compromise
Occipital Condyle Fracture Treatments (2)
- Rare
- Type I & II - cervical orthotic for 6-8 weeks or halo for 8-12 weeks
- Type III - cervical orthotic if AO joint is stable, halo if minimal displacement of AO joint, or OCC-C2 PSF if AO joint is unstable
Atlanto-Occipital Dislocation (AOD) (2)
- Dislocation of skull from Atlas (C1)
- Rare, high mortality rate
Jefferson Fracture (3)
- Fracture of Atlas (C1), arches of C1 burst outwards due to axial loading on the occiput
- Rarely causes neurological involvement
- Usually accompanied by fracture of C2 dens, and transverse ligament damage
Jefferson Fracture Treatment (3)
- Cervical orthotic is 2mm displacement
- Traction/halo used if >2mm displacement
- Atlas/Axis (AA) fusion if significantly unstable
C2 Odontoid Fracture (4)
- Fracture of the dens of C2 Axis
- Seen in young males (risk taking behavior) or elderly due to osteoporosis
- High incidence of non-union (low blood flow)
- Small risk of neuro involvement
C2 Odontoid Fracture Treatment (5)
- Type I - cervical orthotic
- Type II <5mm displacement = immediate halo
- Type II >5mm displacement = PSF/ant. screw
- Type III <5mm = immediate halo
- Type III >5mm = traction/halo
C2 Axis Fracture (4)
- AKA Hangman’s fracture or Traumatic Spondylosthesis
- Caused by traumatic hyperextension of neck (whiplash)
- Results in fracture at pars interarticularis (spinous process distracts away from rest of vertebra)
- Displacement (not distraction) of the vertebra may cause neuro involvement
C2 Axis Fracture Treatment (3)
- Type I - cervical orthotic
- Type II - traction, halo
- Type III - PSF, ORIF
Distraction-Flexion Injury (3)
- Caused by distraction on a flexed neck (MVA, sports injuries)
- C5-C6 and C6-C7 are most vulnerable
- Usually occurs as unilateral or bilateral facet dislocations and posterior longitudinal ligament injury
What is the Bowtie Sign?
Unilateral dislocation/subluxation of facet results in shift in spinous process location.
Distraction-Flexion Injury Treatment (3)
- Immediate closed reduction
- Immobilization w/ cervical orthotic
- Disc herniation requires posterior stabilization and anterior compression.
Vertical Compression Injury (3)
- Usually occurs due to MVA or diving
- C5, 6 and 7 most vulnerable
- Compression on anterior and middle columns
Vertical Compression Injury Treatment (2)
- Stable w/ little kyphosis = cervical orthotic
- Unstable w/ kyphosis = PSF, orthotic or halo
Compression-Flexion Injury
- AKA teardrop fracture
- Caused by compression w/ forcible flexion
- Associated w/ stability compromise
Compression-Flexion Injury Treatment
- ACDF or PSF and orthotic
Lateral Flexion Injury (2)
- Associated with MVA or blow to the head
- Usually managed with soft or rigid collar
Thoracic Spine Fractures
- Caused by metastatic disease, compression, and trauma
- Flexion is contributing factor
- Transitional vertebrae most vulnerable due flexible cervical and lumbar spine moving on rigid thoracic spine
Thoracic Fracture Types (5)
- Compression - failure of anterior column, low risk of neuro compromise
- Burst - axial loading, neuro compromise common
- Flexion Distraction
- Transverse fracture line
- Dislocation - considered unstable, often affects all 3 columns
Thoracic Dislocation Treatment
Conservative - postural reduction, functional bracing, bedrest
Surgical - anterior/posterior decompression and fusion
Lumbar Fractures
- T11-L2 must vulnerable
- Caused by hyperflexion, shear, rotation and compression forces
- Associated with hindfoot and burst fractures
Lumbar Fracture Treatment
- Rigid Orthotics - Molded jackets/braces
- Surgery depends on amount of kyphosis, neuro involvement, instability and displacement
Scoliosis
- Abnormal lateral curvature of the spine, causes rotation of ribs and reduction of air cavity space
- Can be idiopathic or neuropathic etiology
Scoliosis Treatment
- Conservative - bracing and PT
- Surgical - curvature is greater than 40-50 degrees, respiratory compromise is major concern. Use Herrington rods
What should PT focus on most with patients who are post fracture/fusion?
Mobility!!!
What mobility training can PTs work on with spinal fracture patients?
- Bed mobility (log-rolling)
- Educate patients to avoid flexion/rotation w/ ADLs
- Use assistive device for early ambulation
- Discontinue assistive device later to progress activity
How long do activity limitations typically last for scoliosis patients treated with surgery?
Approx. 1 year
What rehab is used for scoliosis patients treated with surgery?
- Similar to fusion rehab
- Use device early to initiate ambulation
What type of fracture is characterized as a burst fracture of the bilateral anterior/posterior arches of C1 that is usually caused by axial loading of the occiput?
Jefferson Fracture
What fracture is caused by traumatic hyperextension that results in bilateral pars interarticularis fractures?
Hangman’s fracture aka C2 Axis fracture or traumatic spondylolisthesis
What type of rare dislocation results in separation of the skull from the spine?
Atlanto-occipital dislocation (AOD)
What type of fracture is often seen in either young risk takers or in older people w/ osteoporosis that results in a fracture of the dens?
C2 Odontoid fracture
What causes a distraction-flexion injury?
- Distraction load on a flexed neck
- Leads to unilateral or bilateral facet dislocations and posterior longitudinal ligament damage
Vertical compression injuries result in __________ and shortening of the _________ and __________ columns.
compression, anterior, middle
What kind of fracture is caused by compression w/ forced flexion and is often associated w/ compromised stability such as facet dislocations, ligament ruptures, or disc tearing?
Teardrop or Compression-flexion
______ and ______ are most commonly injured in thoracic spine fractures.
T12 and L1
Lumbar fracture MOI usually involves _____________ w/ or w/out shear, _________, and _________ compression forces.
Hyper-flexion, rotation, axial
Lumbar fractures most commonly involve the _________ region and are associated w/ hindfoot and _______ fractures.
T11-L2, burst
T/F: The L2-L5 region is the must susceptible area for lumbar fractures.
False, T11-L2 and L5-S1 are the most unstable; L2-L5 is stabilized due to size and surrounding muscles.
T/F: The most vulnerable vertabrae for distraction-flexion injuries are C2-C5.
False, C5-C6 and C6-C7
What are the most vulnerable vertebrae of vertical compression injuries?
C5, 6 and 7
Why are Jefferson fractures rarely associated with neurological involvement?
Burst fracture fragments usually burst outwards rather than inwards towards the spine.
T/F: Lower spine injuries are more common in younger patients whereas cervical injuries are more common in older patients.
False, reverse it
Atlanto-Occipital Dislocation Treatment (2)
- Some can be treated w/ reduction and immobilization w/ halo
- MOST will require PSF of Occ-C2
