Spine: Trauma Flashcards
What is the ASIA Impairment scale? What is the association of each class with ambulation on follow up?
What is the role of steroid therapy in acute spinal cord injury?
considered as an option if can start within 8 hours of SCI (methylprednisolone 30 mg/kg over 1 hour then 5.4 mg/kg/hour for 23 hours)
Occipital condyle fractures are due to ____.
axial load
What are the three types of condyle fractures? What are the treatments?
Type I: stable comminuted fracture; treated with collar.
Type II: stable basal skull fracture involving condyle; treated with collar.
Type III: alar ligament avulsion of medial condyle fragment, unstable; treated with halo vest for 6–12 weeks
What is the Rule of Spence?
on open-mouth view, total overhang of both C1 lateral masses > 7 mm = probable transverse ligament disruption and rigid immobilization is required
Odontoid fractures are usually caused by _____.
flexion injuries
What are the types of odontoid fractures? How does the type affect healing and treatment?
Type I: through tip of odontoid, rare, usually stable.
Type II: at base of odontoid, least likely to heal with immobilization, 30% nonunion overall with 10% nonunion if < 6 mm displacement, but up to 70% nonunion if ≥ 6 mm displacement. Surgery indicated if age ≥ 50 years, displacement ≥ 6 mm, instability in halo vest, and nonunion
Type III: through body of C2. 90% heal with immobilization (halo vest preferred)
Hangman fractures are caused by ______.
hyperextension and axial loading (think head first diving)
What are the types of hangman fractures as defined by Effendi? What is the associated treatment for each?
Type I: fracture through isthmus with < 3 mm displacement, stable injury, neurologic injury rare, treatment is collar.
Type II: fracture through isthmus with disruption of C2–C3 disk and posterior longitudinal ligament (PLL) with increased displacement, slight angulation, and anterolisthesis C2 on C3; may be unstable, neurologic deficit is rare, treated with reduction and halo vest for 12 weeks
Type IIa: fracture has less displacement but more angulation than type II, unstable, treated with reduction and halo vest for 12 weeks.
Type III: fracture in which C2–C3 facet capsules disrupted followed by isthmus fracture and possibly anterior longitudinal ligament (ALL) disruption and C2–C3 locked facets, unstable and mostly associated with neurologic deficit, treatment typically open surgical reduction of facet dislocation and fusion
What is the Subaxial Injury Classification and Severity Score?
Facet dislocation fractures occur with _____.
flexion distraction injuries
What are tear drop fractures?
Hyperflexion causing injury to disk, facet joints, and all ligaments (highly unstable), associated with small bone chip off anteroinferior vertebral body edge (often mistaken as stable minor avulsion) and posterior displacement of fractured vertebral body into spinal canal. Typically present with severe SCI or anterior cord syndrome. Surgical stabilization required and typically combines anterior decompression and posterior fusion
What is the most common type of thoracolumbar fx?
burst fx
What eprcent of chance fxs have abdominal organ injury?
>50%
What is the Thoracolumbar Injury Classification and Severity Score?
