Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PTRS 746 > Spinal Fractures > Flashcards

Spinal Fractures Flashcards

1
Q

How are fractures usually classified?

A

I (stable), II (unstable), III (unstable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What things factor into management of fractures?

A

fracture stability, alignment, neurologic involvement, age, compliance, etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the most commonly injured areas of the spine?

A

lower cervical spine and thoracolumbar junction
2/3 involve C-spine
lower injuries common in adults, upper injuries in children
40% associated with neurologic involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the three columns of spine?

A

Anterior column: anterior longitudinal ligament, anterior 2/3 of vertebral body and annulus fibrosis
Middle column: posterior longitudinal ligament, posterior 1/3 of vertebral body and annulus
Posterior column: posterior ligament complex and vertebral arch structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is stability?

A

refers to immediate or subsequent risk of spinal cord and spinal nerve root injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What makes an injury stable?

A

do not have significant bone or joint displacement; ligamentous structures remain in intact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are examples of stable injuries?

A

compression fractures, traumatic disc herniations, unilateral facet dislocations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What makes an injury unstable?

A

show or have potential for significant displacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are examples of unstable injuries?

A

fracture dislocations, bilateral facet dislocations;

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Fractures involving 1 column

A

stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Fractures involving 3 columns

A

unstable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Fractures involving 2 columns

A

usually follow middle column, if it’s stable the injury is stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are causes of cervical fractures?

A

usually traumatic: MVA, fall, violence, sports, etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How are cervical fractures grouped?

A

can be occipital cervical or subaxial (C3-C7)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the nature of cervical injuries?

A

usually avulsive or due to compression or impaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is outcome of cervical injuries?

A

high mortality above C4

relativelty large cord space compared to T and L spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are 4 treatment components of c spine injuries?

A

immobilization
ongoing neurological examination
imaging
stabilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the two stabilization options?

A

Conservative: closed reduction, traction, bracing
Surgical: decompression, posterior and/or anterior fusion (posterior approach appears to offer increased stability)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 4 different braces used for conservative stabilization?

A

aspen 4 post
Halo
Miami J collar
Philadelphia collar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are treatments for occipital condyle fracture?

A

Type I and II: cervical orthosis (6-8 wks) or halo (8-12 wks)
Type III: cervical orthosis is no AO instability, Halo if minimally displaced, Occ-C2 PSP if unstable (bilateral facet dislocation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is treatment for atlanto-occipital dislocation?

A

associated with spinal cord involvement
careful immobilization and reduction with positioning and halo
often require occ-C2 PSF
very rare to have and few survive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is MOI for atlas fracture?

A

usually due to axial loading of the occiput: burst fracture of bilateral anterior and posterior arches
AKA jeffersons fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Are atlas fractures are associated with other injuries?

A

Yes. associated with other C-spine injuries, especially fracture of dens C2. Often accompanied by transverse ligament tear or avulsion fracture. rarely associated with neurologic injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is treatment for atlas fracture?

A

cervical orthosis if minimally displaced (2mm or if accompanied by other fractures
AA fusion if significant instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is cause of C2 (odontoid) fracture?

A

bimodal distribution of incidence: risk taking behavior in young population, osteoporosis in elderly population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is C2 fracture associated with?

A

High non-union rates, other C spine fractures, 10% incidence of neurologic compromise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are treatment options for the 3 types of odontoid fracture?

A

type I: cervical orthosis
Type II: 5 mm displacement, 10 degree angulation-traction and PSF or anterior screw placement
Type III: 5 mm displacement and 10 degree angulation- traction and halo

28
Q

What is MOI for C2 (axis) fracture?

A

AKA hangman’s fracture or traumatic spondylolisthesis

traumatic hyperextension causes bilateral pars interarticularis fractures

29
Q

What is treatment for C2 fracture?

A

Distraction (not fracture) causes neuro compromise
Type I: cervical orthosis
Type II: halo, with or without traction
Type III: ORIF of C2, with C2-3 PSF

30
Q

How are subaxial cervical injuries treated?

A

lower C spine injury is assumed until proven otherwise

early corticosteroid use and surgical stabilization are indicated for all cases of radiographic neuro compromise

usually managed with anterior decompression/fusion

31
Q

What are types of subaxial cervical fractures?

A 
distraction-flexion
unilateral facet dislocation (bowtie sign)
vertical compression
compression-flexion
lateral flexion
32
Q

What is distraction flexion injury? MOI?

A

distraction load on flexed neck
facet dislocation (uni or bilateral) and posterior longitudinal ligament (PLL) compromise
MOI: MVA, sports

33
Q

What are the most vulnerable regions for distraction flexion injuries?

A

C5-6 and C6-7

34
Q

What is a bowtie sign?

A

unilateral dislocation/subluxation resulting in bowtie appearance at level of injury in lateral view
AP view reveals shift in spinous processes at level of injury

35
Q

What is treatment of unilateral facet dislocation

A

immediate closed reduction
posterior stabilization, anterior decompression and stabilization if disc is herniated
immobilization with cervical orthotic: soft collar, Miami J, aspen collar, Philadelphia collar

36
Q

What is MOI of vertical compression injury?

A

compresses and shortens anterior and middle columns

pattern associated with MVA or diving

37
Q

What is affected in vertical compression injury?

A

C5, C6, C7 more vulnerable

38
Q

What is treatment for stable vertical compression injury?

A

little kyphosis

cervical orthosis

39
Q

What is treatment for unstable vertical compression injury

A

with kyphosis or canal compromise
ACDF with/without PSF
rigid orthosis, potentially a halo

40
Q

What is another name for compression flexion injury?

A

tear drop fracture

41
Q

What often accompanies compression flexion injury?

A

compromised stability (facet dislocation, ligament rupture, disk tearing)

42
Q

What is treatment for compression flexion?

A

ACDF with/without PSF and cervical orthosis

43
Q

What is MOI of lateral flexion injury?

A

MVA, blow to the head

44
Q

What is treatment of lateral flexion injury?

A

rarely involve ligamentous injury requiring surgical stabilization
often managed with soft/rigid collars

45
Q

What is more commonly affected in thoracic spine fractures?

A

bimodal distribution of incidence
transitional vertebrae (cervicothoracic, T1-4; thoracolumbar, T9-12) commonly affected
T12 and L1 injured most frequently
neurological compromise occurs in 15-20%

46
Q

What is MOI?

A

compression, metastatic disease, trauma, flexion force usually contributes to injury

47
Q

How are thoracic fractures managed?

A

varies based on:
stability, spinal cord compromise
presence of rib or sternal involvement
loss of vertebral height

48
Q

What are the high risk areas of spine?

A

Transitional zone: opposition of flexible C and L spine against rigid T spine

49
Q

Where does cauda equine begin?

A

approximately L2

50
Q

What is compression thoracic spine fracture?

A

failure of anterior column, low risk of neurologic compromise

51
Q

What is a thoracic spine burst fracture?

A

result of axial loading, often associated with neurologic compromise

52
Q

What is thoracic spine flexion distraction (seatbelt) fracture?

A

transverse fracture line, rather rare

53
Q

What is a thoracic spine dislocation?

A

considered unstable, often involving failure of all 3 columns and transverse process fracture or costal articulation

54
Q

What is conservative treatment for thoracic dislocation?

A

postural reduction, bedrest (with or without bracing), functional bracing

55
Q

What is surgical treatment for thoracic dislocation?

A

anterior/posterior decompression and fusion

56
Q

What causes lumbar spine fractures?

A

hyperflexion with/without shear, rotation, and axial compression are most common mechanisms
commonly associated with hindfoot and burst fractures

57
Q

When is surgery considered for lumbar spine fractures?

A

need for surgical stabilization predicted by presence of lumbar kyphosis

58
Q

What lumbar region is more susceptible for lumbar spine fractures?

A

T11-L2 region

59
Q

What is T11-L2 are susceptible too?

A

injury and instability

60
Q

Does L2-L5 region get a lot of fractures?

A

structure size and protective musculature stabilize joint

61
Q

L5-S1 fractures?

A

unstable, largely due to force necessary to cause injury

62
Q

What is treatment for lumbar spine fractures?

A

surgical stabilization as indicated by instability, displacement, or neurologic deficit

Rigid orthotics (e.g. TLSO, LSO)

Molded jackets, braces, corsets

63
Q

What do you focus on for acute PT interventions?

A

MOBILITY
immobilization is common post surgical stabilization
Focus on mobility, rather than strengthening specific back musculature
Progressive mobility training within neurologic prognosis
log rolling strategies for bed mobility
avoidance of flexion and rotational movements with ADLs
use of assistive device to promote early ambulation
discontinuation of spinal orthotic allows for progression of activity

64
Q

What is two treatment options for scoliosis?

A

conservative: bracing and physical therapy
surgical: usually if curvature >40-50 degrees, ideally after growth is complete

65
Q

What do we focus on for interventions for PT?

A

treatment similar to fusion
recovery depends on extent of surgery, need for thoracotomy
early use of device to initiate ambulation
activity limitations remain for approximately 1 year

PTRS 746 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions