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PTRS 746 Exam 1 > Spine Fracture and Rehabilitation > Flashcards

Spine Fracture and Rehabilitation Flashcards

1
Q

Content: 3 classifications for fractures of the spine

A

1 = stable

2 = unstable

3 = unstable

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2
Q

Content: What 5 factors that determine spine fracture management

A
  1. stability
  2. alignment
  3. neurologic involvement
  4. age
  5. compliance
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3
Q

Q: What 2 areas of the spine are most commonly injured?

A
  1. lower c-spine
  2. T-L junction
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4
Q

Q: _____ of spinal injuries involve the c-spine.

A

2/3

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5
Q

Q: ________ injuries common in adults, ________ injuries common in children.

A

Lower, upper

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6
Q

Q: _____ of spinal fractures are associated with neurologic involvement.

A

40%

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7
Q

Content: Define the location of the anterior column

A

Anterior longitudinal ligament, anterior 2/3 of vertebral body, and annulus fibrosus

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8
Q

Content: Define the location of the middle column

A

Posterior longitudinal ligament, posterior 1/3 of vertebral body, and annulus

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9
Q

Content: Define the location of the posterior column

A

Posterior ligament complex and vertebral arch structures

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10
Q

Diagram: Anterior, middle, and posterior columns

A
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11
Q

Term: refers to immediate or subsequent risk or spinal cord and spinral nerve root injury

A

Stability

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12
Q

Q: __________ injuries do not have significant bone or joint displacement, ______________ structures remain intact.

A

Stable, ligamentous

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13
Q

Q: What are some examples of stable injuries?

A

Compression, traumatic disc herniation, unilateral facet dislocation

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14
Q

Q: __________ injuries show or have potential for significant ________________.

A

Unstable, displacement

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15
Q

Q: What are some examples of unstable injuries?

A

Fracture-dislocations, bilateral facet dislocations

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16
Q

Q: Fractures involving ____ column are stable while fractures involving ____ columns are unstable.

A

1, 3

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17
Q

Q: Fractures involving 2 columns usually follow the __________ column.

A

Middle

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18
Q

Q: What is the typical MOI for cervical fractures?

A

MVA, fall, violence, sports

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19
Q

Content: Types of cervical fractures (5)

A
  1. Occipital cervical
  2. Subaxial (C3-C7)
  3. Avulsive
  4. Compression
  5. Impaction
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20
Q

Q: Why are cervical fractures above C4 high mortality?

A

Due to control of the diaphragm occuring at C3,4,5

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21
Q

T/F: The cervical spine has a relatively small cord space compared to the T/L-spine.

A

False, large

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22
Q

Content: Treatment of C-spine injury (4)

A
  1. Immobilization
  2. Ongoing neurological examination
  3. Imaging
  4. Stabilization
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23
Q

Content: Conservative stabilization methods (3)

A
  1. Closed reduction
  2. Traction
  3. Bracing
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24
Q

Content: Surgical stabilization methods (2)

A
  1. Decompression
  2. Posterior/Anterior fusion/instrumentation
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25
Q

Q: Which surgical approach appears to offer increased stability?

A

Posterior fusion/instrumentation

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26
Q

Diagram: Identify the type of brace

A

Halo with vest

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27
Q

Diagram: Identify the type of brace

A

Collar

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28
Q

T/F: Occipital condyle fractures are common.

A

False: rare

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29
Q

Content: Typical treatment for a type 1 or 2 occiptial condyle fracture (2)

A
  • Cervical orthosis for 6-8 wks OR
  • Halo for 8-12 wks
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30
Q

Content: Typical treatment for a type 3 occipital condyle fracture (3)

A
  • Cervical orthosis if no AO instability
  • Halo if minimally displaced
  • Occ-C2 posterior spinal fusion (PSF)
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31
Q

Q: What is another name for an atlanto occipital dislocation?

A

Internal decapitation

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32
Q

T/F: Atlanto-occipital dislocations are rare.

A

True

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33
Q

Content: Atlanto-occipital dislocation (3)

A
  1. associated with spinal cord involvement
  2. careful immobilization and reduction with positioning and halo
  3. often require Occ-C2 PSF
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34
Q

Content: Atlas Fracture (4)

A
  1. Usually due to axial loading of the occiput
  2. “Burst” fracutre of the bilateral anterior and posterior arches
  3. 1/2 assoc. with other c-spine injuries (typically C2)
  4. Often accompanied by transverse ligaments tear or avulsion fracture
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35
Q

Q: What is another name for an atlas fracture?

A

Jefferson fracture

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36
Q

T/F: Atlas fractures are commonly associated with neurologic injury.

A

False: rarely

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37
Q

Diagram: Identify the type of fracture

A

Atlas fracture

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38
Q

Content: Treatment of an atlas fracture (3)

A
  1. < 2mm displaced = cervical orthosis
  2. > 2mm displaced/other fractures = traction and halo
  3. significant instability = AA fusion
39
Q

Defn: Non-union

A

A fracture that does not heal and remains unstable due to a lack of blood supply

40
Q

Content: C2 (odontoid) fracture population (2)

A
  1. Risk taking youth
  2. Osteoporotic elderly
41
Q

T/F: C2 (odontoid) fractures have high non union rates.

A

True

42
Q

T/F: C2 (odontoid) fractures are rarely associated with other c-spine fractures.

A

False, often

43
Q

Q: _____% incidence of neurlogic compromis with C2 (odontoid) fractures.

A

10

44
Q

Diagram: Types of occipital cervical injuries

A
45
Q

Q: What is the typical treatment for a type 1 occipital cervical injury

A

Cervical orthosis

46
Q

Q: What is the typical treatment for a type 2 occipital cervical injury with < 5mm displacement and 10 degrees of angulation?

A

Immediate halo

47
Q

Q: What is the typical treatment for a type 2 occipital cervical injury with > 5mm displacement and 10 degrees of angulation?

A

Traction and PSF or anterior screw placement

48
Q

Q: What is the typical treatment for a type 3 occipital cervical injury with < 5mm displacement and 10 degrees of angulation?

A

Immediate halo

49
Q

Q: What is the typical treatment for a type 3 occipital cervical injury with > 5mm displacement and 10 degrees of angulation?

A

Traction and halo

50
Q

Q: What is another name for a C2 (axis) fracture?

A

Hangman’s fracture or traumatic spondylolisthesis

51
Q

Q: What causes C2 (Axis) fractures?

A

Traumatic hyperextension

52
Q

Diagram identify which is a type 1 and type 2 C2 (axis) fracture

A

Type 1 on left, Type 2 on right

53
Q

Q: What type of C2 (axis) fracture causes neuro compromise?

A

Distraction (not fracture)

54
Q

Q: What is the treatment plan for a type 1, 2, and 3 C2 (axis) fracture?

A

Type 1 = cervical orthosis

Type 2 = halo with or without traction

Type 3 = open reduction internal fixation (ORIF) of C2, with C2-3 PSF

55
Q

Content: Typical Type 1, 2, 3, fracture treatments

A

Type 1 = cervical orthosis

Type 2 and 3 = halo with or without traction

56
Q

T/F: Lower c-spine injury is assumed until proven otherwise.

A

True

57
Q

Q: Early _______________ use and _________ stabilization are indicated for ____ cases of radiographic neurologic compromise.

A

Corticosteroid, surgical, all

58
Q

Q: How are subaxial cervical injuries usually managed?

A

With anterior cervical decompression/fusion (ACDF)

59
Q

Content: Subaxial cervical distraction-flexion injury (4)

A
  1. distraction load on flexed neck
  2. common MOI = MVA
  3. most vulnerable regions = C5-6 and C6-7
  4. facet dislocation (U/B) and posterior longitudinal ligament compromise
60
Q

Q: What causes a bowtie sign?

A

A unilateral facet dislocation or subluxation of the subaxial servical spine

61
Q

Content: Treatment of subaxial cervical injuries (3)

A
  1. Immediate closed reduction
  2. Posterior stabilization and anterior decompression with stabilition if disc is herniated
  3. Immobilization with a cervical orthotic
62
Q

Content: Subaxial cervical - vertical compression injury (3)

A
  1. MOI = MVA or diving
  2. Most vulnerable = C5-7
  3. Compresses and shortens anterior and middle columns
63
Q

Q: What is the treatment for a subaxial cervical vertical compression that is stable with little kyphosis?

A

Cervical orthosis

64
Q

Q: What is the treatment for a subaxial cervical vertical compression that is unstable with kyphosis or canal compromise? (2)

A
  1. ACDF with/without PSF
  2. Rigid othrosis, potentially a halo
65
Q

Q: What is the name of a compresion flexion injury to the subaxial c-spine?

A

Tear drop fracture

66
Q

Q: What often accompanies a tear drop fracture?

A

Compromised stability

67
Q

Q: What is the treatment for a tear drop fracture?

A

ACDF with/without PSF and cervical orthosis

68
Q

Content: Subaxial cervical lateral flexion injury (4)

A
  1. MOI = MVA, blow to head
  2. Usually minimal clinical findings
  3. Rarely involve ligament injury requiring surgery
  4. Often managed with soft/rigid collars
69
Q

Q: What is the most frequently fractured thoracic spine?

A

T12 and L1

70
Q

Q: Which thoracic spine zones are most commonly affected?

A

The transitional vertebrai T1-4 and T9-12

71
Q

Q: What % of thoracic spine fractures involve neurological compromise?

A

15-20

72
Q

Q: What is the MOI for thoracic spine fractures? (3)

A
  1. Compression
  2. Metastatic disease
  3. Trauma
73
Q

Q: What type of force typically causes thoracic spine injury?

A

Flexion force

74
Q

T/F: Thoracic spine fractures have a bimodal distribution of incidence.

A

True

75
Q

Q: Where does cauda equina being?

A

L2

76
Q

Content: Management basis for thoracic spine fractures (3)

A
  1. stability, spinal cord compromise
  2. presence of rib or sternal involvement
  3. loss of vertebral height
77
Q

Q: Opposition of ____________ C/L-spine against ________T-spine place transitional zones at ______ risk.

A

flexible, rigid, high

78
Q

Term: Thoracic spine fractures: Failure of anterior column, low risk of neurologic compromise

A

Compression

79
Q

Term: Thoracic spine fractures: Result of axial loading, often associated with neurologic compromise

A

Burst

80
Q

Term: Thoracic spine fractures: Transverse facture line, rather rare

A

Flexion distraction (seatbelt)

81
Q

Term: Thoracic spine fractures: Considered unstable, often involving failure of all 3 columns and transverse process fracture or costal articulation

A

Dislocation

82
Q

Q: What is the conservative approach to T-spine fractures? (3)

A
  1. Postural reduction
  2. Bedrest
  3. Functional bracing
83
Q

Q: What is the surgical approach to T-spine fractures?

A

Anterior/posterior decrompression and fusion

84
Q

Q: What region of the lumbar spine is most susceptible to fractures?

A

T11-L2

85
Q

Q: What is the most common MOI for L-spine fractures?

A

Hyperflexion

86
Q

Q: With L-spine fractures, the need for surigcal stabilization is predicted by the presence of lumbar ___________.

A

Kyphosis

87
Q

Q: Which region of the L-spine’s structure size and protective musculature sabilize the joints?

A

L2-L5

88
Q

Q: Which region of the L-spine is unstable, largely due to force necessary to casue injury?

A

L5-S1

89
Q

Q: What type of orthosis is used for L-spine fracture?

A

TLSO (rigid), Jewett hyperextension brace, lumbosacral corset

90
Q

Q: What should be the focus of acute PT interventions post fracture or fusion?

A

mobility rather than strengthening specific back musculature

91
Q

Q: What movements should be avoided post fracture or fusion?

A

Flexion and rotation

92
Q

Q: When is surgery appropriate for scoliosis?

A

If the curvature is > 40-50 degrees and after growth is complete

93
Q

Q: How long do activity limitations remain after a surgical scoliosis repair?

A

1 year

PTRS 746 Exam 1 (9 decks)

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