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NYCC Bone & Joint > TL Fractures > Flashcards

TL Fractures Flashcards

1
Q

What theory is used to determine stability of TL spinal fractures?

A

3 column theory of Denis

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2
Q

What makes up the anterior column of the TL spine?

A

anterior 2/3 of vertebral body

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3
Q

What makes up the middle column of the TL spine?

A

posterior 1/3 of vertebral body

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4
Q

What makes up the posterior column of the TL spine?

A

posterior elements

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5
Q

According to the 3 column theory of Denis, when is a fracture considered stable?

A

if only 1 column is affected
(eg. compression Fx = ant column)

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6
Q

According to the 3 column theory of Denis, when is a fracture considered unstable?

A

2 or more columns involved (eg. burst fx, chance fx)

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7
Q

Which column of the TL spine cannot fracture by itself? Is this stable or unstable?

A

middle column = unstable

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8
Q

What is the one exception to the middle column rule regarding TL spine stability?

A

traumatic posterior limbus bone

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9
Q

What is the stability of a fracture that involves the anterior column only, but greater than 50% vertebral body height is lost?

A

probably unstable

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10
Q

What populations do compression fractures occur most in?

A
  • 35%: F, >45, w/ postmenopausal osteoporosis
  • 30%: secondary osteoporosis
  • 25%: acute trauma (otherwise healthy)
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11
Q

What are the possible mechanisms of a compression fracture?

A
  • osteoporosis w/ minor trauma
  • insufficiency fx
  • acute trauma: hyperflexion and/or axial load
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12
Q

What are the most common sites of compression fractures?

A

T11-L1

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13
Q

What is the typical shape of a thoraco-lumbar compression fracture?

A

wedge-shaped

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14
Q

What are the possible shapes of lower lumbar compression fractures?

A
  • wedge
  • central endplate fx
  • biconcave “fish”
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15
Q

What population are lower lumbar compression fractures common in?

A

older females

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16
Q

What structures are damaged with a biconcave (fish) shaped compression fracture?

A

Fx of both sup + inf endplates

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17
Q

What mechanism is indicated by vertebra plana?

A

pathologic (not traumatic)

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18
Q

What are the 3 most important imaging characteristics to determine a new versus old compression fracture?

A

New Fx may have:
- zone of impaction
- step defect
- paraspinal edema
(if 1 of 3, likely acute)

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19
Q

When is paraspinal edema visible on x-ray?

A
  • compression Fx of T12 or above
  • AP t/s view
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20
Q

What is a zone of impaction?

A

faint white line on x-ray along compression Fx line

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21
Q

What is the stability of a TL compression fracture?

A

stable

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22
Q

What is your next step if your patient has a compression fracture?

A

refer to orthopedist for pain control

23
Q

Name an indirect indicator of a new compression fracture.

A

abdominal ileus
(^pain -> ^sympathetic tone + deactivated PSNS -> bowel fills w/ gas due to ^methanogenic bacteria breaking down food)

24
Q

Name an indirect indicator of an old compression fracture.

A

Degenerative disc disease (wedge-shaped, osteophytes, less disc space)

(injured jt = ^DJD w/in 2 yrs)

25
Q

How would a new compression fracture appear on T2 MRI compared to an old fracture?

A

New Fx has bone marrow edema = bright on T2

26
Q

What must be ruled out first before diagnosing a compression fracture?

A

burst & chance Fxs
(both have ant wedging + unstable)

27
Q

Burst fractures involve how many columns?

A

2-3

28
Q

What is the clinical significance of a burst fracture?

A

up to 50% probability of neurologic injury d/t retropulsion & decreased canal space
(lower % in lumbar)

29
Q

What is the stability of a fracture if the posterior body is convex?

A

unstable
(= middle column inj)

30
Q

What radiographic findings are specific to burst fractures?

A
  • retropulsion of middle column body fragments
  • vertical splitting of body
  • comminution of body
  • focal widening of interpedicle distance (indicates post element fx)
31
Q

What is your next step for a patient with a burst fracture?

A

emergency transport
(CT for osseous fragments, MRI for cord/nerve root damage)

32
Q

What column is involved with a posterior limbus bone?

A

ONLY the middle column

33
Q

What is the stability of a posterior limbus bone?

A

stable

34
Q

What is the clinical significance of a posterior limbus bone?

A

concern for neuro compromise from stenosis

35
Q

What is the mechanism of a transverse process fracture?

A

direct flank trauma or extension w/ lat flexion

36
Q

What is the 2nd most common lumbar fracture?

A

transverse process Fx

37
Q

What is the differential diagnosis for a TP fracture?

A

ununited TP ossification center

38
Q

What organ injury is associated with a TP fracture?

A

kidney or ureter

39
Q

What imaging is required to determine organ damage associated with a TP fracture?

A

abdomen CT w/ IV contrast

40
Q

What is the stability of a TP fracture?

A

stable
(typically heal non-union)

41
Q

What is another name for a chance fracture?

A

lap belt Fx

42
Q

What is the mechanism of a chance fracture?

A

flexion & distraction over a fulcrum

43
Q

What vertebral structures are damaged with a chance fracture?

A

horizontal splitting of:
- post vertebral body
- spinous
- pedicles (or lamina)

44
Q

What radiographic sign is associated with a chance fracture on an AP view?

A

empty vertebra sign
(d/t splitting & displacement of pedicles)

45
Q

What organ injury is most commonly damaged in association with a chance fracture?

A

spleen
(also pancreas, aorta, viscera)

46
Q

What is the diagnosis?

A

Compression Fx

47
Q

What is the diagnosis?

A

Transverse process fx

48
Q

What is the diagnosis?

A

Burst fx

49
Q

What is the diagnosis?

A

Butterfly vertebra

50
Q

What is the stability of this injury?

A

Stable
(Dx: Compression fracture)

51
Q

What is the diagnosis? Name a radiographic sign.

A

Chance Fx
Empty vertebra sign

52
Q

What is the diagnosis?

A

Transverse process Fx

53
Q

What is the diagnosis?

A

Traumatic pars Fx

54
Q

What is the diagnosis?

A

Chance Fx

NYCC Bone & Joint (20 decks)

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