Repeat

Question 2

The most common cause of thoracolumbar burst fractures?

Answer 2

Substantial Axial loading force

Question 3

What two types of fractures has predilection for the thoracolumbar spine?

Answer 3

• Burst frx
• vertebral body
• axial load
• failure of anterior and middle column
• Compression frx
• anterior column involved
• middle column intact
• usually stable frx.
• typically fall in elderly or osteoporotic pt.

Question 4

What is a AOD?

Answer 4

Atlantooccipital dislocation

Question 5

WHat is the treatment of an atlantooccipital dislocation?

Answer 5

1. Immidiately IMMOBILISE.
   Obs Traction has a 10% risk of deterioration.
2. Internal fixation and arthodesis ( fusion)

Question 6

Contraindications for closed reduction in the spine

Answer 6

• Atlantooccipital disslocation (10% deterioration risk)
• Hangman type IIA or type III.
• Skull defect/frx at the anticipated site of the pin for reduction.
• caution in children under 3yo
• caution in elderly
• demineralised skull
• additional rostral injury
• Patients w movement disorders

Question 7

How is a anterior atlantoaxial subluxation required?

Answer 7

Disruption of TAL - transverse atlantal ligament
Or from an incompetent odontoid process.

Question 8

the most common frx location in motorcycle injuries?

Answer 8

Th6 (upper thoracical spine)

Question 9

What is the most common axis frx?

Answer 9

Odontoid frx.

Question 10

WHat is the grading score for odontoid frx?

Answer 10

Anderson and D’Alonzo

Question 11

How common are flexion injuries of the subaxial cervical spine?

Answer 11

15% of cervical spine trauma.

Question 12

What is a prototypical accident to cause subaxial flexion injury?

Answer 12

Compression-flexion as a dive on shallow water.

Question 13

What is a teardrop frx?

Answer 13

A teardrop just beyond the anterior inferior edge of the injured vertebra.
Caused by hyperflexion or axial load at vertex of the skull with flexed neck.

Question 14

What is important to look for in teardrop frx?

Answer 14

If the inferior margin of the frx vertebrae is displaced into the canal = Unstable.

Question 15

If everything speaks for an extension-avulsion frx - what does greenberg suggest to do w the pt?

Answer 15

*Make a flexion-extension XR. if ok
* Discharge w rigid collar. * New CT once pain subsided

Question 16

Why is a new CT after pain subsided important in ext-avulsion fractures?

Answer 16

To rule out that a musclespasm didnt maintain alignment and a teardrop frx is the actual cause.

Question 17

What approach is used for teardrop frx (disrupted anterior ligament etc)

Answer 17

Anterior and posterior approach.

Question 18

How many % of patients are intact after a unilateral locked facet?

Answer 18

25%

Question 19

How many % of patients have a root deficiency, an incomplete cord injury and a complete paraplegia after unilateral locked facet injury?

Answer 19

37%, 22% and 15% respectively.

Question 20

How many patients with a bilateral locked facet injury have a complete quadriplegia?

Answer 20

65-90%

Question 21

What are the two options to manual reduction of locked facetts?

Answer 21

1. posterior surgery - will not help the disc
2. anterior surgery - the disc will be removed and then manual traction applied.

Question 22

What ttype of frx is usually in Th10-L2 and caused by axial load with a 50% risk of deficit and 5% paraplegia?

Answer 22

Burst fractures.

Question 23

What is a “Chance frx”?

Answer 23

Its a horizontal, classically 1 level frx purely involving bone; splitting the spinous process, lamina, pedicles and VB.

Question 24

Why is it important to immidiately immobilize someone with atlanto-occipital dislocation? (2/3 are children)

Answer 24

Traction might lead to bulbar-cervical dissociation and cruciate paralysis, respiratory arrest, anoxia and death.

Question 25

There are three types of atlas frx. Type 2 is a so called burst fracture that is used to be called something else. What?

Answer 25

Jefferson frx.

Question 26

What is usually the cause of Jefferson frx?

Answer 26

Axial load - blow out frx.

Question 27

How many % of Jefferson frx also involve a C2 frx?

Answer 27

44%

Question 28

What part of C1 is injured in a Type 3 frx?

Answer 28

The lateral mass.

Question 29

Where is a Hangman frx situated?

Answer 29

In pars articularis of C2 (pedicles). - causing disruption of C2-C3 junction. (compression of posterior column)

Question 30

Mechanism of injury of a hangman frx?

Answer 30

hyperextension and distraction. Eg. classifaclly a blow on the forehead. (falls or car accidents)

Question 31

what is Grisel syndrome?

Answer 31

Rare cause of torticollis. Subluxation of atlanto-axial joint due to ligamentous laxity. Young children Follows inflammation of head/neck usually a retropharyngeal abscess. Can also be otitis media. Ab and soft collar,

Question 32

WHat effect is an axial load giving on thoracic spine?

Answer 32

flexion.

Question 33

WHat effect does axial load have on lumbar spine?

Answer 33

increased extension

Question 34

what frx ? bilateral pars interarticularis fractures at C2 and is the result of hyperextension and distraction, most commonly due to high velocity trauma

Answer 34

Hangman frx

Question 35

Flexion is most common mechanism in cervical spine fractures and can result in the following injuries:

Answer 35

anterior atlantoaxial subluxation anterior subluxation (hyperflexion sprain) anterior wedge fracture clay-shoveler fracture flexion teardrop fracture bilateral facet dislocation hyperflexion fracture-dislocation Jag har dubbelkollat med radiopedia. Flexion är den vanligaste mechanismen i halsrygg.

Question 36

A plain AP odontoid view of the cervical spine showing asymmetry and displacement of the lateral masses away from the odontoid peg is typically indicative of a...

Answer 36

Jefferson fracture