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Radiology Trauma > Vertebral column fractures > Flashcards

Vertebral column fractures Flashcards

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1
Q

cervical fractures can be subtle and sometimes ___ on xray

A

undetected

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2
Q

what view must be cleared first in the cervical spine for stability before others are attempted

A

lateral cervical view

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3
Q

do not perform __ and __ views before ruling out cord injury

A

flexion and extension

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4
Q

what is often required to fully evaluate cervical spinal cord injury

A

CT

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5
Q

what provides info about neuro and soft tissue damage in cervical spine

A

MRI

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6
Q

what is a significant indicator of underlying cervical injury

A

prevertebral (retropharyngeal and retrotracheal) soft tissue evaluation

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7
Q

what are the distances in width of the prevertebral soft tissues to indicate cervical injury

A

adults

no more than 7 mm at C2 - or should be less than 50% width of C2 vertebral body

no more than 22mm at C6-7 - or should be less than the width of the C6-7 vertebra

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8
Q

what is not a reliable indication of injury in the cervical spine

A

cervical lordosis

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9
Q

absent lordosis in C spine is seen in __ % of normal cases

A

> 20%

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10
Q

what will cause loss of cervical lordosis

A

DDD

cervical muscle spasm

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11
Q

what 4 lines are a good way to evaluate the alignment of the C spine

A

anterior vertebral line
posterior vertebral line (georges line)
spinal laminar line
posterior SP line

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12
Q

posterior disc space widening and fanning of SP at ___ may strongly indicated disruption of ___

A

c3-6 *

PLL*
capsule ligaments
interspinous lig

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13
Q

abrupt change in facet orientation (inferior facets must align with superior facets) may indicate what

A

rotational deformity

facet dislocation

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14
Q

on AP lower cervical view, check SP alignment and exclude what

A

double SP sign indicating SP avulsion*

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15
Q

position of C2 and odontoid in normal xray?

what if it is malpositioned

A

tilts slightly back - if it is leaning anterior suspect odontoid fracture

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16
Q

C1-C2 distance in adults on lateral view is approx __ and shouldnt increase with flexion

A

2.5 mm

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17
Q

C1-C2 distane in children on lateral view is approx ___ and may change by __ in flexion

A

5mm

1-2 mm with flexion

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18
Q

APOM view of C1 lateral masses may slightly overhang in what population? in other cases?

A

children

other cases - suspect fracture

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19
Q

how do we establish if a fracture is stable or unstable

A

3 column denis classification system *

  • if one column injured = stable fracture
  • if 2 or more columns are injured = unstable fracture (disruption of ligaments)

3 vertical columns - anterior( ALL, ant annulus) ant 2/3 body) middle (post 1/3 body, post annulus, PLL) , posterior (pedicles, facets, lamina, SP)

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20
Q

as general rule, most spinal fractures occur due to a __ injury

A

flexion

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21
Q

the greater mobility of the cervical spine means less what

A

stability

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22
Q

what fractures occur at C1

A

posterior arch fracture
jefferson burst fracture
anterior arch fracture
lateral mass fracture

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23
Q

what fractures occur at C2

A

hangmans fracture
odontoid process fracture
teardrop fracture

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24
Q

what fractures occur at mid to lower cervicals

A 
compression wedge or burst fracture 
flexion teardrop* fracture 
pillar fracture 
clay shovelers fracture 
whiplash injury
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25
occipital condyle fractures are unstable fractures that are encountered in what injuries
MVA
26
occipitovertebral dissociation is often __
not common but fatal - gapping of craniocerivcal junction
27
what is the most common fracture of the atlas C1
bilateral fracture of the posterior arch >50%
28
how does bilateral fracture of posterior arch occur
extension compression of C1 arch by occiput
29
BL posterior arch fracture is realtively __ but commonly have other fractures present
stable
30
what is a burst fracture of C1 or atlas called
jefferson fracture
31
C1 osseous ring ossifies at what age
age 3-6
32
C1 osseous ring structure may fracture where
several locations aka burst fracture aka jefferson
33
what is mechanism of jefferson fracture
diving head first compression of occipital condyles into lateral masses of C1
34
in APOM view, if overhanging C1 masses are greater than what combined you should suspect what?
> 6mm suspect transverse ligament damage unstable
35
jefferson burst fracture treatment
stable - conservative care | unstable - ligaments disrupted - neurosurgery fixating C1 to C2
36
odontoid fracture mechanism
due to flexion or extension or combo
37
what are the 3 types of odontoid fractures
type 1 - less common - avulsion of the tip or upper peg type 2 - most common and unstable - fracture through base of odontoid process and may affect cruciate lig - may be missed - high risk of non union type 3 - through base of odontoid body and lateral masses - best healing fracture/ best prognosis
38
what should not be confused with dens fractrure
mach line or effect ossiculum terminale os odontoideum
39
what frature results in traumatic spondylolisthesis (BL break of pars interarticularis) of C2
hangmans fracture
40
hangmans fractures are most commonly due to what
MVA - hyperextension and traction of upper cervical spine
41
is neuro defecit common in hangmans
suprisingly no
42
hangmans fracture that extends to the foramina intertransversaria results in what
vertebral artery damage
43
radiographic findings of hangmans fracture
prevertebral ST swelling anterior dislocation of C2 C2 pars interarticularis or pedicle fracture extension tear drop fragment
44
silver bone may be noted at anterior C2 body with hangmans fracture due to what
extension teardrop fracture caused by avulsion of ALL attachment
45
hyperextension of the C spine may cause avulsion of inferior anterior corner of vertebral body
extension tear drop fracture
46
extnesion tear drop fracture is stable in what position and unstable in what position
stable in flexion | usntable in extension
47
extension tear drop fracture may occur with hangmans fracture especially in older patients due to what
spondylosis | C2-3 vulnerable to more stress
48
what is one of the most severe injuries of the cervical spine that results in anterior cervical cord syndrome and quadriplegia - often paralyzed at site of accident
flexion teardrop fracture
49
flexion tear drop mechanism | MC where
severe flexion and compression (diving head first or MVA) | MC at C5-6
50
in flexion teardrop fracture, anterior cord damage may develop due to __ displacement of vertebral body
posterior
51
flexion teardrop fracture xray findings
``` anterior tear drop fracture widening of facet joint posterior displacement of vertebral body fanning of SPs or SP fracture spinal cord compression ```
52
what fracture is seen on lateral radiographs as an obliqye lucency through the SP at C7
clay shovellers fracture
53
what is most common site of clay shovellers
C7
54
what is the most common mechanism of injury in clay shovellers fracture
sudden muscle contraction austrailians shovelling clay or just sudden impact or direct blow to SP
55
is lay shovellers fracture stable
yes no surgical care needed
56
where does compression wedge fractures take place
cervical, thoracic, and lumbar spine
57
mechanism of injury for compression wedge fracture
hyperflexion injuries to vertebrae from axial loading
58
compression wedge fractures commonly affect what part of vertebral body
anterior
59
compression wedge fractures are considered a __ column fracture
single column - stable
60
Where is the MC location from wedge fractures
thoracic region and TL region
61
simple wedge fractures are MC in the ___ region
TL
62
compression wedge fractures xray findings
anterior compression of vertebrae | step sign - end plate impaction*
63
what fracture is a type of comminuted fracture that results in disruption of posterior vertebral body cortex with retropulsion fragments into spinal canal
burst fractures
64
Burst fractures when involving TL region, what is the most common?
between T9-L5
65
mechanism of injury for burst fracture
high energy axial loading fall and land on feet from height MVA
66
what causes the burst in the burst fracture
nucleus driven into vertebral body and bursts
67
modality to view burst fracture
CT - check for retropulsion fragments in canal as well
68
burst fracture xray findings
burst of posterior vertebral body loss of poterior vertebral height retropulsed fragments in spinal canal interpedicular distance widening - due to burst
69
bilateral cervical facet dislocation is caused by what type of injury
flexion distraction type of injury hyperflexion and traction may be buckling
70
unilateral cervical facet dislocation is caused by what
flexion distraction injury while cervical rotation is present
71
what is common finding on xray seen with perched or dislocated facets
anteriolisthesis - lateral view
72
facet dislocation is stable or unstable
unstable - more than one column is involved
73
what may predispose people to facet dislocations
facet degeneration
74
what is common finding on xray seen with unilateral facet dislocation
bow tie appearence due to sudden facet rotation on lateral cervical view SPs dont align on AP view
75
what is a vertebral facet joint whose inferior articular process appears to sit on the ipsilateral superior articular process of the vertebrae BELOW
perched facet joint
76
any further anterior subluxation after a perched facet joint will result in ___, which one facet will jump over the other and become locked in position leading to ___ that will then lead to overiding facet which leads to ____ which is seen in bilateral facet dislocation
dislocation jumping facets locked facets
77
cervical articular pillar fracture is MC where
C4-C7 C6 is 40% of cases
78
what fractures are often unrecognized at the time and only found incidentally years later
clay shovellers fracture
79
it is important to know that a __ injury may only be discovered years later for unrelated imaging
stable
80
radiographic findings of clay shovellers
fractured C7 SP | double spinous process with inferior displacement
81
what other fractures besides wedge and burst are found in the thoracic and lumbar region
seat belt or chance fracture
82
what is a flexion injury of vertebral column with distraction of posterior elements of the spine that extends through to involve all 3 spinal columns
chance fracture
83
chance fracture is highly unstable and has what complications
intra abdominal trauma | pancreatic, duodenum, kindey injury
84
MC cause of chance fracture
lap part of seat belt back seat passenger in MVA or falling from a height
85
what is modality of choice for viewing chance fracture
CT
86
MC location of chance fracture
T12-L2
87
xray findings for chance fracture
anterior wedge fracture of vertebral body with horizontal fracture through posterior elements or distraction of facet joints and SPs interpedicular widening
88
radiograph evaluation of a whip lash injury is ofen ___
unrewarding
89
what will exclude pillar fracture
CT
90
what helps idenitify ST injury
MRI
91
distraction vs compression injuries
distraction - avulsion, rim lesion, annular hemorrhage, herniation compression - synovial fold brusie, hematoma at DRG, facet hemarthrosis, hemarthrosis of articular pillar

Radiology Trauma (6 decks)

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