Spine Fracture and Rehabilitation Flashcards Preview

PTRS 746 Exam 1 > Spine Fracture and Rehabilitation > Flashcards

Flashcards in Spine Fracture and Rehabilitation Deck (93):
1

Content: 3 classifications for fractures of the spine

1 = stable

2 = unstable

3 = unstable

2

Content: What 5 factors that determine spine fracture management

1. stability

2. alignment

3. neurologic involvement

4. age

5. compliance

3

Q: What 2 areas of the spine are most commonly injured?

1. lower c-spine

2. T-L junction

4

Q: _____ of spinal injuries involve the c-spine.

2/3

5

Q: ________ injuries common in adults, ________ injuries common in children.

Lower, upper

6

Q: _____ of spinal fractures are associated with neurologic involvement.

40%

7

Content: Define the location of the anterior column

Anterior longitudinal ligament, anterior 2/3 of vertebral body, and annulus fibrosus

8

Content: Define the location of the middle column

Posterior longitudinal ligament, posterior 1/3 of vertebral body, and annulus

9

Content: Define the location of the posterior column

Posterior ligament complex and vertebral arch structures

10

Diagram: Anterior, middle, and posterior columns

A image thumb
11

Term: refers to immediate or subsequent risk or spinal cord and spinral nerve root injury 

Stability 

12

Q: __________ injuries do not have significant bone or joint displacement, ______________ structures remain intact.

Stable, ligamentous

13

Q: What are some examples of stable injuries?

Compression, traumatic disc herniation, unilateral facet dislocation 

14

Q: __________ injuries show or have potential for significant ________________.

Unstable, displacement

15

Q: What are some examples of unstable injuries?

Fracture-dislocations, bilateral facet dislocations

16

Q: Fractures involving ____ column are stable while fractures involving ____ columns are unstable.

1, 3

17

Q: Fractures involving 2 columns usually follow the __________ column.

Middle

18

Q: What is the typical MOI for cervical fractures?

MVA, fall, violence, sports

19

Content: Types of cervical fractures (5)

1. Occipital cervical

2. Subaxial (C3-C7)

3. Avulsive

4. Compression

5. Impaction

20

Q: Why are cervical fractures above C4 high mortality?

Due to control of the diaphragm occuring at C3,4,5

21

T/F: The cervical spine has a relatively small cord space compared to the T/L-spine.

False, large

22

Content: Treatment of C-spine injury (4)

1. Immobilization

2. Ongoing neurological examination

3. Imaging

4. Stabilization

23

Content: Conservative stabilization methods (3)

1. Closed reduction

2. Traction

3. Bracing

24

Content: Surgical stabilization methods (2)

1. Decompression

2. Posterior/Anterior fusion/instrumentation 

25

Q: Which surgical approach appears to offer increased stability?

Posterior fusion/instrumentation

26

Diagram: Identify the type of brace

Q image thumb

Halo with vest

27

Diagram: Identify the type of brace

Q image thumb

Collar

28

T/F: Occipital condyle fractures are common.

False: rare

29

Content: Typical treatment for a type 1 or 2 occiptial condyle fracture (2)

- Cervical orthosis for 6-8 wks OR

- Halo for 8-12 wks

30

Content: Typical treatment for a type 3 occipital condyle fracture (3)

- Cervical orthosis if no AO instability 

- Halo if minimally displaced

- Occ-C2 posterior spinal fusion (PSF)

31

Q: What is another name for an atlanto occipital dislocation?

Internal decapitation

32

T/F: Atlanto-occipital dislocations are rare.

True

33

Content: Atlanto-occipital dislocation (3)

1. associated with spinal cord involvement

2. careful immobilization and reduction with positioning and halo

3. often require Occ-C2 PSF

34

Content: Atlas Fracture (4)

1. Usually due to axial loading of the occiput

2. "Burst" fracutre of the bilateral anterior and posterior arches

3. 1/2 assoc. with other c-spine injuries (typically C2)

4. Often accompanied by transverse ligaments tear or avulsion fracture

35

Q: What is another name for an atlas fracture?

Jefferson fracture

36

T/F: Atlas fractures are commonly associated with neurologic injury.

False: rarely 

37

Diagram: Identify the type of fracture

Q image thumb

Atlas fracture 

38

Content: Treatment of an atlas fracture (3)

1. < 2mm displaced = cervical orthosis 

2. > 2mm displaced/other fractures = traction and halo

3. significant instability = AA fusion

39

Defn: Non-union

A fracture that does not heal and remains unstable due to a lack of blood supply 

40

Content: C2 (odontoid) fracture population (2)

1. Risk taking youth

2. Osteoporotic elderly

41

T/F: C2 (odontoid) fractures have high non union rates.

True

42

T/F: C2 (odontoid) fractures are rarely associated with other c-spine fractures.

False, often

43

Q: _____% incidence of neurlogic compromis with C2 (odontoid) fractures.

10

44

Diagram: Types of occipital cervical injuries

A image thumb
45

Q: What is the typical treatment for a type 1 occipital cervical injury

Cervical orthosis

46

Q: What is the typical treatment for a type 2 occipital cervical injury with < 5mm displacement and 10 degrees of angulation?

Immediate halo

47

Q: What is the typical treatment for a type 2 occipital cervical injury with > 5mm displacement and 10 degrees of angulation?

Traction and PSF or anterior screw placement

48

Q: What is the typical treatment for a type 3 occipital cervical injury with < 5mm displacement and 10 degrees of angulation?

Immediate halo

49

Q: What is the typical treatment for a type 3 occipital cervical injury with > 5mm displacement and 10 degrees of angulation?

Traction and halo

50

Q: What is another name for a C2 (axis) fracture?

Hangman's fracture or traumatic spondylolisthesis 

51

Q: What causes C2 (Axis) fractures?

Traumatic hyperextension

52

Diagram identify which is a type 1 and type 2 C2 (axis) fracture 

Q image thumb

Type 1 on left, Type 2 on right

53

Q: What type of C2 (axis) fracture causes neuro compromise?

Distraction (not fracture)

54

Q: What is the treatment plan for a type 1, 2, and 3 C2 (axis) fracture?

Type 1 = cervical orthosis

Type 2 = halo with or without traction

Type 3 = open reduction internal fixation (ORIF) of C2, with C2-3 PSF

55

Content: Typical Type 1, 2, 3, fracture treatments

Type 1 = cervical orthosis

Type 2 and 3 = halo with or without traction

56

T/F: Lower c-spine injury is assumed until proven otherwise.

True

57

Q: Early _______________ use and _________ stabilization are indicated for ____ cases of radiographic neurologic compromise.

Corticosteroid, surgical, all

58

Q: How are subaxial cervical injuries usually managed?

With anterior cervical decompression/fusion (ACDF)

59

Content: Subaxial cervical distraction-flexion injury (4)

1. distraction load on flexed neck

2. common MOI = MVA

3. most vulnerable regions = C5-6 and C6-7

4. facet dislocation (U/B) and posterior longitudinal ligament compromise

60

Q: What causes a bowtie sign?

A unilateral facet dislocation or subluxation of the subaxial servical spine

61

Content: Treatment of subaxial cervical injuries (3)

1. Immediate closed reduction

2. Posterior stabilization and anterior decompression with stabilition if disc is herniated

3. Immobilization with a cervical orthotic 

62

Content: Subaxial cervical - vertical compression injury (3)

1. MOI = MVA or diving

2. Most vulnerable = C5-7

3. Compresses and shortens anterior and middle columns

63

Q: What is the treatment for a subaxial cervical vertical compression that is stable with little kyphosis?

Cervical orthosis

64

Q: What is the treatment for a subaxial cervical vertical compression that is unstable with kyphosis or canal compromise? (2)

1. ACDF with/without PSF

2. Rigid othrosis, potentially a halo

65

Q: What is the name of a compresion flexion injury to the subaxial c-spine?

Tear drop fracture

66

Q: What often accompanies a tear drop fracture?

Compromised stability

67

Q: What is the treatment for a tear drop fracture?

ACDF with/without PSF and cervical orthosis 

68

Content: Subaxial cervical lateral flexion injury (4)

1. MOI = MVA, blow to head

2. Usually minimal clinical findings

3. Rarely involve ligament injury requiring surgery

4. Often managed with soft/rigid collars

69

Q: What is the most frequently fractured thoracic spine?

T12 and L1

70

Q: Which thoracic spine zones are most commonly affected?

The transitional vertebrai T1-4 and T9-12

71

Q: What % of thoracic spine fractures involve neurological compromise?

15-20

72

Q: What is the MOI for thoracic spine fractures? (3)

1. Compression

2. Metastatic disease

3. Trauma

73

Q: What type of force typically causes thoracic spine injury?

Flexion force

74

T/F: Thoracic spine fractures have a bimodal distribution of incidence.

True

75

Q: Where does cauda equina being?

L2

76

Content: Management basis for thoracic spine fractures (3)

1. stability, spinal cord compromise

2. presence of rib or sternal involvement

3. loss of vertebral height

77

Q: Opposition of ____________ C/L-spine against ________T-spine place transitional zones at ______ risk.

flexible, rigid, high

78

Term: Thoracic spine fractures: Failure of anterior column, low risk of neurologic compromise

Compression

79

Term: Thoracic spine fractures: Result of axial loading, often associated with neurologic compromise

Burst

80

Term: Thoracic spine fractures: Transverse facture line, rather rare

Flexion distraction (seatbelt)

81

Term: Thoracic spine fractures: Considered unstable, often involving failure of all 3 columns and transverse process fracture or costal articulation

Dislocation

82

Q: What is the conservative approach to T-spine fractures? (3)

1. Postural reduction

2. Bedrest

3. Functional bracing

83

Q: What is the surgical approach to T-spine fractures?

Anterior/posterior decrompression and fusion 

84

Q: What region of the lumbar spine is most susceptible to fractures?

T11-L2

85

Q: What is the most common MOI for L-spine fractures?

Hyperflexion 

86

Q: With L-spine fractures, the need for surigcal stabilization is predicted by the presence of lumbar ___________.

Kyphosis

87

Q: Which region of the L-spine's structure size and protective musculature sabilize the joints?

L2-L5

88

Q: Which region of the L-spine is unstable, largely due to force necessary to casue injury?

L5-S1

89

Q: What type of orthosis is used for L-spine fracture?

TLSO (rigid), Jewett hyperextension brace, lumbosacral corset

90

Q: What should be the focus of acute PT interventions post fracture or fusion?

mobility rather than strengthening specific back musculature

91

Q: What movements should be avoided post fracture or fusion?

Flexion and rotation

92

Q: When is surgery appropriate for scoliosis?

If the curvature is > 40-50 degrees and after growth is complete

93

Q: How long do activity limitations remain after a surgical scoliosis repair?

1 year