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PTRS 746 > Spinal Fractures > Flashcards

Spinal Fractures Flashcards

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1
Q

How are fractures usually classified?

A

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

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2
Q

What things factor into management of fractures?

A

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

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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

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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

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5
Q

What is stability?

A

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

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6
Q

What makes an injury stable?

A

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

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7
Q

What are examples of stable injuries?

A

compression fractures, traumatic disc herniations, unilateral facet dislocations

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8
Q

What makes an injury unstable?

A

show or have potential for significant displacement

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9
Q

What are examples of unstable injuries?

A

fracture dislocations, bilateral facet dislocations;

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10
Q

Fractures involving 1 column

A

stable

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11
Q

Fractures involving 3 columns

A

unstable

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12
Q

Fractures involving 2 columns

A

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

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13
Q

What are causes of cervical fractures?

A

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

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14
Q

How are cervical fractures grouped?

A

can be occipital cervical or subaxial (C3-C7)

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15
Q

What is the nature of cervical injuries?

A

usually avulsive or due to compression or impaction

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16
Q

What is outcome of cervical injuries?

A

high mortality above C4

relativelty large cord space compared to T and L spine

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17
Q

What are 4 treatment components of c spine injuries?

A

immobilization
ongoing neurological examination
imaging
stabilization

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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)

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19
Q

What are 4 different braces used for conservative stabilization?

A

aspen 4 post
Halo
Miami J collar
Philadelphia collar

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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)

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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

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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

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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

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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

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25
What is cause of C2 (odontoid) fracture?
bimodal distribution of incidence: risk taking behavior in young population, osteoporosis in elderly population
26
What is C2 fracture associated with?
High non-union rates, other C spine fractures, 10% incidence of neurologic compromise
27
What are treatment options for the 3 types of odontoid fracture?
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
What is MOI for C2 (axis) fracture?
AKA hangman's fracture or traumatic spondylolisthesis | traumatic hyperextension causes bilateral pars interarticularis fractures
29
What is treatment for C2 fracture?
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
How are subaxial cervical injuries treated?
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
What are types of subaxial cervical fractures?
``` distraction-flexion unilateral facet dislocation (bowtie sign) vertical compression compression-flexion lateral flexion ```
32
What is distraction flexion injury? MOI?
distraction load on flexed neck facet dislocation (uni or bilateral) and posterior longitudinal ligament (PLL) compromise MOI: MVA, sports
33
What are the most vulnerable regions for distraction flexion injuries?
C5-6 and C6-7
34
What is a bowtie sign?
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
What is treatment of unilateral facet dislocation
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
What is MOI of vertical compression injury?
compresses and shortens anterior and middle columns | pattern associated with MVA or diving
37
What is affected in vertical compression injury?
C5, C6, C7 more vulnerable
38
What is treatment for stable vertical compression injury?
little kyphosis | cervical orthosis
39
What is treatment for unstable vertical compression injury
with kyphosis or canal compromise ACDF with/without PSF rigid orthosis, potentially a halo
40
What is another name for compression flexion injury?
tear drop fracture
41
What often accompanies compression flexion injury?
compromised stability (facet dislocation, ligament rupture, disk tearing)
42
What is treatment for compression flexion?
ACDF with/without PSF and cervical orthosis
43
What is MOI of lateral flexion injury?
MVA, blow to the head
44
What is treatment of lateral flexion injury?
rarely involve ligamentous injury requiring surgical stabilization often managed with soft/rigid collars
45
What is more commonly affected in thoracic spine fractures?
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
What is MOI?
compression, metastatic disease, trauma, flexion force usually contributes to injury
47
How are thoracic fractures managed?
varies based on: stability, spinal cord compromise presence of rib or sternal involvement loss of vertebral height
48
What are the high risk areas of spine?
Transitional zone: opposition of flexible C and L spine against rigid T spine
49
Where does cauda equine begin?
approximately L2
50
What is compression thoracic spine fracture?
failure of anterior column, low risk of neurologic compromise
51
What is a thoracic spine burst fracture?
result of axial loading, often associated with neurologic compromise
52
What is thoracic spine flexion distraction (seatbelt) fracture?
transverse fracture line, rather rare
53
What is a thoracic spine dislocation?
considered unstable, often involving failure of all 3 columns and transverse process fracture or costal articulation
54
What is conservative treatment for thoracic dislocation?
postural reduction, bedrest (with or without bracing), functional bracing
55
What is surgical treatment for thoracic dislocation?
anterior/posterior decompression and fusion
56
What causes lumbar spine fractures?
hyperflexion with/without shear, rotation, and axial compression are most common mechanisms commonly associated with hindfoot and burst fractures
57
When is surgery considered for lumbar spine fractures?
need for surgical stabilization predicted by presence of lumbar kyphosis
58
What lumbar region is more susceptible for lumbar spine fractures?
T11-L2 region
59
What is T11-L2 are susceptible too?
injury and instability
60
Does L2-L5 region get a lot of fractures?
structure size and protective musculature stabilize joint
61
L5-S1 fractures?
unstable, largely due to force necessary to cause injury
62
What is treatment for lumbar spine fractures?
surgical stabilization as indicated by instability, displacement, or neurologic deficit Rigid orthotics (e.g. TLSO, LSO) Molded jackets, braces, corsets
63
What do you focus on for acute PT interventions?
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
What is two treatment options for scoliosis?
conservative: bracing and physical therapy surgical: usually if curvature >40-50 degrees, ideally after growth is complete
65
What do we focus on for interventions for PT?
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)

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