Part 1 Flashcards by Rachael Beverage

Should we take xrays of the skull?

No, less than 10% of skull fractures are detected on xray
skull anatomy is very complex
interpretation is very difficult

How well did you know this?

Not at all

Perfectly

what does the patient need if you suspect a skull fracture?

How well did you know this?

Not at all

Perfectly

tripod fracture

when all 3 major attachments of the zygoma are separated from the rest of the face

How well did you know this?

Not at all

Perfectly

what are the requirements for spine trauma xrays?

xrays must be of diagnostic quality
need appropriate views
old films can be helpful

How well did you know this?

Not at all

Perfectly

what are the different mechanisms of trauma?

hyperflexion**
hyperflexion and rotation
hyperextension
hyperextension and rotation
vertical compression
lateral flexion

How well did you know this?

Not at all

Perfectly

what are the different types of hyperflexion injuries?

compression fracture
bilateral interfacial dislocation
flexion teardrop fracture
clay shoveler's fracture
anterior subluxation
dens fracture

How well did you know this?

Not at all

Perfectly

what are the types of hyperflexion and rotation injuries?

unilateral interfacetal dislocation

unilateral interfacetal fracture-dislocation

How well did you know this?

Not at all

Perfectly

hyperextension fractures

avulsion of anterior tubercle of C1
hyperextension fracture-dislocation
hyperextension dislocation
posterior arch fracture of C1
extension teardrop fracture
hangman's fracture
lamina fracture
dens fracture

How well did you know this?

Not at all

Perfectly

hyperextension rotation fractures

pillar fracture

pedicolaminar fracture

How well did you know this?

Not at all

Perfectly

vertical compression fractures

jeffersons fracture of C1

bursting fracture of lower cervical spine

How well did you know this?

Not at all

Perfectly

lateral flexion fractures

unilateral fracture, lateral mass of C1
transverse process fracture
uncinate fracture

How well did you know this?

Not at all

Perfectly

where are the most common spinal traumas?

C1-2
C5-7
T12-L1

How well did you know this?

Not at all

Perfectly

what percentage of cervical traumas end up with neurological injury?

40%

How well did you know this?

Not at all

Perfectly

what percent of spinal traumas end up with spinal cord injuries overall?

10-14%

How well did you know this?

Not at all

Perfectly

what percent of thoracolumbar traumas end up with neurological injury?

10%

How well did you know this?

Not at all

Perfectly

if you suspect cervical spine trauma, what should you do?

take a 7 view cervical spine series

“Davis series”

How well did you know this?

Not at all

Perfectly

what is included in the 7 view cervical spine series?

lateral
APOM
AP cervical
right and left obliques
flexion and extension
swimmers

How well did you know this?

Not at all

Perfectly

what should you do if you have a diagnosis before you finish the entire 7 view cervical series?

stop and take care of it

How well did you know this?

Not at all

Perfectly

when is a fracture stable or unstable?

unstable: middle column, 2 or more columns
stable: anterior column only, posterior column only

How well did you know this?

Not at all

Perfectly

what if you have a new spinal fracture?

orthopedic consult

How well did you know this?

Not at all

Perfectly

how do you treat a stable injury?

more conservatively

How well did you know this?

Not at all

Perfectly

retropharyngeal space

7mm

How well did you know this?

Not at all

Perfectly

retrotracheal space

22mm

signs of spine trauma (abnormal vertebral alignment)

misalignment
loss of lordosis
acute kyphotic angulation
widened interspinous spaces
vertebral rotation
torticollis

signs of spine trauma (abnormal joints)

increased ADI abnormal disc height widened apophyseal joints

other signs of spinal trauma

vacuum cleft disc an angle of 11 degrees or more of flexion compared to adjacent levels greater than 3.5mm body offset maybe a clue to instability

radiographic features of severe sprain

widening of interspinous distance loss of parallelism between facet joints horizontal displacement angular displacement of greater than 11 degrees compared to adjacent interspaces

antero/retrolisthesis can be due to:

``` fracture dislocation ligamentous laxity DJD anatomic physiologic ```

how fast can spinal fractures heal?

3-6 months

body fractures heal more with..

fibrosis

arch fractures heal more with

callus

posterior arch fracture

MC fracture of atlas usually bilateral and vertical in orientation hyperextension mechanism

other name for jefferson's fracture

bursting fracture of C1

what is jefferson's fracture?

axial compression injury bilateral fracture of anterior and posterior arches bilateral lateral mass offset

when is a jefferson's fracture definitely unstable?

when the transverse ligament is torn (>7mm)

when is ADI most common

traumatic rupture is ___in ADIs

rare

ADIs are considered..

unstabile

what do you do when you find an increased ADI?

DON'T adjust | orthopedic consult

what are the max ADIs for children and adults?

children: 5mm adults: 3mm

what are some etiologiesfor ADIs

``` normal variant trauma down's syndrome major UC anomaly inflammatory arthropathies ```

what should you do if there is an increase in ADI

take flexion and extension films

which film is better for seeing ADIs, flexion or extension?

flexion

steele's rule of thirds

``` ring of atlas is 1/3 cord 1/3 odontoid 1/3 potential space anterior displacement may be asymptomatic ```

40-50% of axis fractures are..

dens fractures

name the types of odontoid fractures and how common they are

type I: oblique fx of the tip (4%) type II: fx at the base (66%) type III: fx into the body 30%)

type I dens fractures are stable or unstable?

stable and rare

type II dens fractures are stable or unstable?

unstable and most common

type III dens fractures are stable or unstable?

unstable when broken | stable when healed

which dens fracture are non unions common?

type II

what is disrupted with type III dens fractures?

Harris' ring

describe type I dens fx

uncommon avulsion of the tip distraction by apical or alar ligament

describe type II dens fx

transverse or oblique fx through base best seen on APOM nonunion very cmmon unstable

if the dense is more than 5mm displaced in a type II dens fx, what does that mean?

100% nonunion

T/F: most os odontoideum are old ununited dens fx

true

T/F: most old ununited dens fx are os odontoideums

false

describe type III dens fractures

``` below junction of dens and C2 body mechanically unstable may disrupt Harris' ring altered body contour "fat C2 body" best seen on lateral may need specialized again ```