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PTRS 746 Musculoskeletal > Spinal Fractures > Flashcards

Spinal Fractures Flashcards

1
Q

Spine Fracture Classifications (3)

A

I - Stable

II - Unstable

III - Unstable

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2
Q

Fracture Management Areas (5)

A
  • Fracture stability
  • Fracture alignment
  • Neurological involvement
  • Age
  • Patient compliance w/ interventions
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3
Q

What are the most common spinal injuries?

A
  • C-spine (2/3)
  • T-L region
  • 40% associated with neurological involvement
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4
Q

Anterior Spinal Column

A

Anterior longitudinal ligament through 2/3 of vertebral body/annulus fibrosis

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5
Q

Middle Column

A

Posterior 1/3 of vertebral body/annulus fibrosis to posterior longitudinal ligament

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6
Q

Posterior Column

A

Posterior longitudinal ligament through remaining vertebral arch structures

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7
Q

Stable Spinal Fractures

A
  • Patient does not have significant joint displacement and no neurological involvement.
  • Ligaments usually remain intact
  • Examples - compression fractures, disc herniations, unilateral facet dislocation
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8
Q

Unstable Spinal Fractures

A
  • Patient is at high risk for neurological involvement due to significant displacement of fracture
  • Examples - fracture dislocations, bilateral facet dislocations
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9
Q

Spinal Stability

A

Amount of risk of spinal cord or spinal nerve root damage

  • 1 column = stable
  • 3 columns = unstable
  • 2 columns follows middle column
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10
Q

Cervical Fracture Causes (2)

A
  • Usually caused by MVA, violence, and sports
  • Usually avulsive, compression or impaction related injuries
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11
Q

Cervical Fracture Categories (2)

A
  1. Occipital-cervical (occipital bone, C1, C2)
  2. Subaxial (C3-C7)
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12
Q

Why is a fracture at C4 and above the most dangerous?

A

Will cause respiratory function compromise

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13
Q

Occipital Condyle Fracture Treatments (2)

A
  • Rare
  • Type I & II - cervical orthotic for 6-8 weeks or halo for 8-12 weeks
  • Type III - cervical orthotic if AO joint is stable, halo if minimal displacement of AO joint, or OCC-C2 PSF if AO joint is unstable
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14
Q

Atlanto-Occipital Dislocation (AOD) (2)

A
  • Dislocation of skull from Atlas (C1)
  • Rare, high mortality rate
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15
Q

Jefferson Fracture (3)

A
  • Fracture of Atlas (C1), arches of C1 burst outwards due to axial loading on the occiput
  • Rarely causes neurological involvement
  • Usually accompanied by fracture of C2 dens, and transverse ligament damage
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16
Q

Jefferson Fracture Treatment (3)

A
  • Cervical orthotic is 2mm displacement
  • Traction/halo used if >2mm displacement
  • Atlas/Axis (AA) fusion if significantly unstable
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17
Q

C2 Odontoid Fracture (4)

A
  • Fracture of the dens of C2 Axis
  • Seen in young males (risk taking behavior) or elderly due to osteoporosis
  • High incidence of non-union (low blood flow)
  • Small risk of neuro involvement
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18
Q

C2 Odontoid Fracture Treatment (5)

A
  • Type I - cervical orthotic
  • Type II <5mm displacement = immediate halo
  • Type II >5mm displacement = PSF/ant. screw
  • Type III <5mm = immediate halo
  • Type III >5mm = traction/halo
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19
Q

C2 Axis Fracture (4)

A
  • AKA Hangman’s fracture or Traumatic Spondylosthesis
  • Caused by traumatic hyperextension of neck (whiplash)
  • Results in fracture at pars interarticularis (spinous process distracts away from rest of vertebra)
  • Displacement (not distraction) of the vertebra may cause neuro involvement
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20
Q

C2 Axis Fracture Treatment (3)

A
  • Type I - cervical orthotic
  • Type II - traction, halo
  • Type III - PSF, ORIF
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21
Q

Distraction-Flexion Injury (3)

A
  • Caused by distraction on a flexed neck (MVA, sports injuries)
  • C5-C6 and C6-C7 are most vulnerable
  • Usually occurs as unilateral or bilateral facet dislocations and posterior longitudinal ligament injury
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22
Q

What is the Bowtie Sign?

A

Unilateral dislocation/subluxation of facet results in shift in spinous process location.

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23
Q

Distraction-Flexion Injury Treatment (3)

A
  • Immediate closed reduction
  • Immobilization w/ cervical orthotic
  • Disc herniation requires posterior stabilization and anterior compression.
24
Q

Vertical Compression Injury (3)

A
  • Usually occurs due to MVA or diving
  • C5, 6 and 7 most vulnerable
  • Compression on anterior and middle columns
25
Q

Vertical Compression Injury Treatment (2)

A
  • Stable w/ little kyphosis = cervical orthotic
  • Unstable w/ kyphosis = PSF, orthotic or halo
26
Q

Compression-Flexion Injury

A
  • AKA teardrop fracture
  • Caused by compression w/ forcible flexion
  • Associated w/ stability compromise
27
Q

Compression-Flexion Injury Treatment

A
  • ACDF or PSF and orthotic
28
Q

Lateral Flexion Injury (2)

A
  • Associated with MVA or blow to the head
  • Usually managed with soft or rigid collar
29
Q

Thoracic Spine Fractures

A
  • Caused by metastatic disease, compression, and trauma
  • Flexion is contributing factor
  • Transitional vertebrae most vulnerable due flexible cervical and lumbar spine moving on rigid thoracic spine
30
Q

Thoracic Fracture Types (5)

A
  • Compression - failure of anterior column, low risk of neuro compromise
  • Burst - axial loading, neuro compromise common
  • Flexion Distraction
  • Transverse fracture line
  • Dislocation - considered unstable, often affects all 3 columns
31
Q

Thoracic Dislocation Treatment

A

Conservative - postural reduction, functional bracing, bedrest

Surgical - anterior/posterior decompression and fusion

32
Q

Lumbar Fractures

A
  • T11-L2 must vulnerable
  • Caused by hyperflexion, shear, rotation and compression forces
  • Associated with hindfoot and burst fractures
33
Q

Lumbar Fracture Treatment

A
  • Rigid Orthotics - Molded jackets/braces
  • Surgery depends on amount of kyphosis, neuro involvement, instability and displacement
34
Q

Scoliosis

A
  • Abnormal lateral curvature of the spine, causes rotation of ribs and reduction of air cavity space
  • Can be idiopathic or neuropathic etiology
35
Q

Scoliosis Treatment

A
  • Conservative - bracing and PT
  • Surgical - curvature is greater than 40-50 degrees, respiratory compromise is major concern. Use Herrington rods
36
Q

What should PT focus on most with patients who are post fracture/fusion?

A

Mobility!!!

37
Q

What mobility training can PTs work on with spinal fracture patients?

A
  • Bed mobility (log-rolling)
  • Educate patients to avoid flexion/rotation w/ ADLs
  • Use assistive device for early ambulation
  • Discontinue assistive device later to progress activity
38
Q

How long do activity limitations typically last for scoliosis patients treated with surgery?

A

Approx. 1 year

39
Q

What rehab is used for scoliosis patients treated with surgery?

A
  • Similar to fusion rehab
  • Use device early to initiate ambulation
40
Q

What type of fracture is characterized as a burst fracture of the bilateral anterior/posterior arches of C1 that is usually caused by axial loading of the occiput?

A

Jefferson Fracture

41
Q

What fracture is caused by traumatic hyperextension that results in bilateral pars interarticularis fractures?

A

Hangman’s fracture aka C2 Axis fracture or traumatic spondylolisthesis

42
Q

What type of rare dislocation results in separation of the skull from the spine?

A

Atlanto-occipital dislocation (AOD)

43
Q

What type of fracture is often seen in either young risk takers or in older people w/ osteoporosis that results in a fracture of the dens?

A

C2 Odontoid fracture

44
Q

What causes a distraction-flexion injury?

A
  • Distraction load on a flexed neck
  • Leads to unilateral or bilateral facet dislocations and posterior longitudinal ligament damage
45
Q

Vertical compression injuries result in __________ and shortening of the _________ and __________ columns.

A

compression, anterior, middle

46
Q

What kind of fracture is caused by compression w/ forced flexion and is often associated w/ compromised stability such as facet dislocations, ligament ruptures, or disc tearing?

A

Teardrop or Compression-flexion

47
Q

______ and ______ are most commonly injured in thoracic spine fractures.

A

T12 and L1

48
Q

Lumbar fracture MOI usually involves _____________ w/ or w/out shear, _________, and _________ compression forces.

A

Hyper-flexion, rotation, axial

49
Q

Lumbar fractures most commonly involve the _________ region and are associated w/ hindfoot and _______ fractures.

A

T11-L2, burst

50
Q

T/F: The L2-L5 region is the must susceptible area for lumbar fractures.

A

False, T11-L2 and L5-S1 are the most unstable; L2-L5 is stabilized due to size and surrounding muscles.

51
Q

T/F: The most vulnerable vertabrae for distraction-flexion injuries are C2-C5.

A

False, C5-C6 and C6-C7

52
Q

What are the most vulnerable vertebrae of vertical compression injuries?

A

C5, 6 and 7

53
Q

Why are Jefferson fractures rarely associated with neurological involvement?

A

Burst fracture fragments usually burst outwards rather than inwards towards the spine.

54
Q

T/F: Lower spine injuries are more common in younger patients whereas cervical injuries are more common in older patients.

A

False, reverse it

55
Q

Atlanto-Occipital Dislocation Treatment (2)

A
  • Some can be treated w/ reduction and immobilization w/ halo
  • MOST will require PSF of Occ-C2

PTRS 746 Musculoskeletal (9 decks)

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