Trauma

Question 1

How are Occipital Condyle Fractures classified?

Answer 1

Anderson and Montesano.

1 - Comminuted (Impaction Injury, Generally Stable as ligaments in tact)
2 - Linear (Direct blow, generally stable as ligaments intact)
3 - Avulsion (Rotation injury. Risk of ligament injury / OC Dislocation - Potentially Unstable).

Question 2

What are the ligaments securing C0-2?

Answer 2

Apical
Alar x 2
Transverse
Tectorial Membrane

Question 3

How much movement does the Atlanto-occipital joint allow?

Answer 3

Combined flexion and extension 25°
One-side lateral bending 5°
One-side axial rotation 5°

Question 4

How much movement occurs at the Atlanto-axial ?

Answer 4

Combined flexion and extension 20°
One-side lateral bending 5°
One-side axial rotation 40°–45°

Question 5

What are the indications for CVJ Fixation?

Answer 5

Occipital Condyle Type 3
Occipital Cervical Dislocation
Basilar Invagination with Compression

Question 6

30mph RTC.

What is the diagnosis and next line investigation?

Answer 6

C6 Tear Drop Fractue.

Hard collar and MRI

Question 7

What is the management for this:

Answer 7

C6 Tear drop with evidence of disc injury and interspinous.

Key thing next is to look at the facets to evaluate flexion vs extension.

Concern is distraction, as in flexion facets have to ride up over the inferior articulate process (more energy. These are the bad ones that present with locked facets). Vs distraction which if the superior facet is injured could slip backwards.

If facets in tact. Hard collar 6 weeks and review.

If facets injured hard collar still a good option but need earlier clinical review to make sure no movement.