Spine Fractures

Question 1

Atlas #. Epidemiology, mechanisms, investigation, management, complications

Answer 1

Jefferson fractures
7% of c spine injuries

Hyper extension/lateral/axial compression

X-ray-> lateral/ open mouthed odontoid view

Stable-> cervical othosis 6-12w
Unstable-> C1/2 fusion

Low risk of neural injury

Question 2

Axis #. Epidemiology, mechanisms, investigation, management, complications

Answer 2

Hangmans #
Odontoid peg most common

Elderly -> falls
Young-> hyperflexion/extension

X-ray-> lateral, AP, open mouth

Stable-> cervical orthosis 6-12w
Unstable-> fusion

Question 3

C3-7#. Epidemiology, mechanisms, investigation, management, complications

Answer 3

Compression-> crushed ant. Vertebral body -> stable
Burst-> # extension through the the post. Cortex-> canal compression
Flexion tear drop-> ant compression and post tension
Extension tear drop avulsion-> stable

Stable-> collar 6-12w
Unstable-> decompression and fusion

Question 4

Thoracolumbar burst #. Epidemiology, mechanisms, investigation, management, complications

Answer 4

Anterior and middle column
Axial loading with flexion
Thoracolumbar junction
Canal compressed at time of injury

X Ray AP and lateral

Stable-> orthosis
Unstable-> decompression and stabilisation

Neuro damage

Question 5

Chance #. Epidemiology, mechanisms, investigation, management, complications

Answer 5

Middle and posterior column

X Ray AP and lateral and flexion extension

Stable-> immobilisation in cast/orthosis
Unstable-> decompression and stabilisation

50% GI injury
Neuro damage

Question 6

Causes of spinal trauma

Answer 6

Falls 41.7%
RTA 36%
Sport
Assault

Question 7

Spinal trauma clinical features

Answer 7

Pain at injury level
Deformity 
Tenderness
Swelling
Bony step
Abnormal neurology

Question 8

Potential causes for decline in neurology

Answer 8

Resp failure-> c/t spine
Hypoxia-> poor airway
Oedema-> increased compression
Ischaemia 
Neurogenic shock-> circulatory collapse from loss of sympathetic tone

Question 9

Spinal shock explanation and symptoms

Answer 9

Loss of supra spinal control 
Transient 48h to 6w 
Worse in higher injuries
-> complete loss of motor, sensory, reflex and autonomic bellow lesion 
30-60mins following injury

Vasomotor and vice real paralysis-> bladder retention
Flaccid a reflexive paresis
Hypotension and bradycardia
Poikilothermia

Question 10

Spinal trauma investigations

Answer 10

X Ray

MRI/CT for ligaments