2.7 Ankle Fractures COPY

Question 1

What has happened in a wedge fracture of the thoracolumbar spine?
How do you classify the stability?

Answer 1

Anterior part of body collapses leaving posterior part intact.

Often fragility fracture in elderly.

Denis classification for spinal fractures. Divide spine into 3 columns, if only one column is fracture then is it considered to be stable.
(posterior complex, middle component, anterior column)

Question 2

History and exam finding in fragility fractures of the thoracolumbar spine (aka wedge fracture)?

Investigations?

Answer 2

• elderly patient fallen from standing height
• acute onset low back pain
• pain well localised and limits movement
• neuro exam should be normal, some radicular pain over dermatome

X-ray is best but:

• hard to tell if its old or new fracture
• hard to tell osteoporotic vs metastasis

CT can be used to:

• help grade stability (Denis)
• retropulsion of fragments into spinal cord

MRI for:

• more info about soft tissues
• especially if there are neurological features

Question 3

Management of a wedge fracture?

Answer 3

• traditionally its conservative
• early mobilisation and analgesia help this succeed
• some evidence for thoracolumbar support braces

KYPHOPLASTY has become a more recent option

• percutaneous injection of cement
• GA or local anaesthetic
• stabilises anterior column = pain relief and quicker return to function.

Question 4

C-spine injury can happen in all age groups. What imaging would you use?

Answer 4

• traditionally plain xray but this isn’t very useful
• AP and a lateral, may need “swimmers view” in short necks
• “peg view” take through the open mouth

TRAUMA:

• CT is initial imaging
• from vertex to symphsis
• if neuro involvement then also MRI