Trauma Flashcards
Types of occipital condylar fractures
- Type 1: comminuted condylar fracture that is typically due to an axial load injury
- Type 2: A basilar skull fracture extending into the occipital condyle
- Type 3: is avulsion of a fragment from the inferomedial condyle with partial or complete disruption of the tectorial membrane and contralateral alar ligament.
What is the white cerebellum sign?
Aka reversed cerebellum sign. Due to severe brain edema, resulting in hyperdense appearance of the cerebellum and midbrain, which have blood supply maintained.
3 most common locations of DAI
Grey-white junction, corpus callosum, dorsolateral midbrain
Components of ZMC fractures (Tripod)
- Fracture of zygomatic arch, temporozygomatic suture diastasis
- Fracture of inferior orbital rim or ant/post walls of maxillary sinus, diastasis of zygomaticomaxillary suture
- Fracture of lateral orbital rim or diastasis of frontozygomatic suture
Subtypes of Lefort (mid face) fractures
Le Fort 1 - horizontal fracture through maxillary sinus walls
Le Fort 2 - pyramidal fracture, sparing medial walls, allows free movement of nose and hard palate
Le Fort 3 - complete mid face dissociation, with fractures through the zygomatic arches
DDx for hyperintense signal on FLAIR in addition to SAH
- Meningitis, leptomeningeal carcinomatosis - both of these will usually enhance (other: oxygen or propofol)
- Look for blood on GRE
Most common cause of morbidity of patients with SAH
Vasospasm; peak at 7 days
Other complications: hydro, superficial siderosis (present with sensorineural hearing loss and ataxia)
List MR appearances of each stage of hemorrhage
It Be IdDy BiDdy BaBy DooDoo (T1, T2) Hyperacute < 6 hrs - Iso, Bright Acute 6-72 hours - Iso, Dark Early subacute <1 week - Bright, Dark Late subacute >1 week-months - Bright, bright Chronic - Dark, dark
Intracellular and extracellular MethHB are both:
Bright on T1
Except only extra-cellular is bright on T2
List the named spine fractures
Jefferson C1 - post and ant arches, axial loading
Odontoid fracture C2 - (3 types), usually hyperflexion; type II is considered unstable (type III can be stable or unstable)
Hangman’s fracture C2 bilateral pedicle or par interarticularis - hyperextension, disruption of spinolaminar lines
Clay-shoveler’s - spinous process hyperflexion (C7)
Flexion teardrop - most unstable** - disruption of posterior vertebral and spinolaminar lines, resulting in posterior displacement of vertebral body and anterior cord syndrome (can also get extension teardrop which is less severe and occurs in upper to mid cervical spine versus flexion teardrop which is lower)
Chance - flexion distraction, seatbelt, hyper-flexion, horizontal fracture through posterior elements
Burst fracture - axial loading injury involving anterior and middle columns (2/3 columns involved)
Locked facets - hyperflexion, disruption of all spinal ligaments, anterior dislocation of affected vertebra by 50% (perched facet is less severe); unstable injury if bilateral, high risk cord damage
List unstable spinal fractures
Flexion tear drop Bilateral facet dislocation Odontoid 2 (and 3) Two contiguous columns, or 3 column Jefferson Hangman Atlanto-occipital and atlanto-axial dislocations Other: anterolisthesis >4 mm, kyphosis >11 degrees
Which injury is associated with anterior cord syndrome
Flexion teardrop - complete paralysis
What is Brown Sequard
One side motor, other side sensory loss
Rotational injury or penetrating trauma
Involves entire half of cord
Normal atlanto-dental interval
<3 mm adults
<5 mm children
