Lecture 4: Spinal Fractures 1 (Intro, Upper and Lower C/S)

What are the 2 Types of Spinal Injury?

• Stabe Injury

• Unstable Injury

Types of Spinal Injury:

• Define:

  • Stable Injury

  • Unstable Injury

• Stable:

  • Vertebral component will NOT BE displaced by normal movement

• Unstable:

  • There is a risk that normal movement WILL LEAD TO displacement and resulting spinal tissue injury

Label these 4 Lines? (C/S)

Spinal Column Fracture:

• Define the 3 Column Concept:

• Anterior Column

• Middle Column

• Posterior Column

3 Column Concept:

• What structures are included in:

  • Anterior Column:

    • 2

  • Middle Column:

    • 2

  • Posterior Column:

    • 4

• Anterior Column

  • Anterior Longitudinal Ligament

  • Ant. 2/3 of Vertebral Body

• Middle Column

  • Posterior 1/3 of the Vertebrae

  • Posterior Longitudinal Ligament

• Posterior Column

  • Posterior Ligament Complex

  • Vertebral Arch

  • Facets

  • Ligamentum Flavum

Spinal Column Rules:

• What are the 3 Spinal Column Rules?

• Spinal Cord and Canal are located Posterior to the Middle Column in the Posterior Column

• Fx in the Posterior and Middle Column have potential to encroach on the Spinal Cord and Canal

• MRI is needed to determine the level of injury, if any, to the spinal cord

Three Column Concept:

• Fractures involving ONE COLUMN are ___.

• Fractures involving THREE COLUMNS are ___.

• Fractures involving TWO COLUMNS depends on what? (2)

• If the Middle Column is Intact, it is usually a ___ injury.

• One Column:

  • Stable

• Three Columns:

  • Unstable

• Two Columns

  • May or may not be unstable

  • Depends on the severity of the injury

• Middle is intact

  • Stable

Upper C/S Fx

Fracture of C1: Jefferson Fx

• What type of Fx is a Jefferson Fx?

• AKA:

• MOI:

• Structures affected:

• Compression Fx

• MOI:

  • Hyper Ext or Flexion Injury of the Head

• AKA:

  • Burst Fx

• Structures affected:

  • Anterior and Posterior Arches of the Atlas

Fracture of C1: Jefferson Fx

• Rarely causes ___ injury

  • What direction of neck movement can cause head to slide forwards and compress SC?

• Requires what type of view to diagnose?

• Note displacement of what structure?

• Neurological Injury

  • Fwd flex w Jefferson Fx

• Open mouth view

• Lateral Mass Displacement

Fracture of C2: Hangman’s Fx

• What type of Fx is this?

• Bilateral Fx of the pedicles of C2 w dislocation of vertebral body C2 on C3

Fracture of C2: Hangman’s Fx

• MOI:

• __ for info on the SC

• Stable or Unstable Fx

• MOI:

  • Hyper Extension Injury in MVA

• MRI

• Unstable

Fracture of the Axis: Dens

• AKA:

• __% of C/S Fx

• Higher chance of __ involvement due to attachments of what 2 ligaments?

• MC:

• Often occurs w __ trauma

• AKA:

  • Ondontoid Fx

• 20%

• Neurological Involvement due to attachments of Alar and Transverse Ligs

• MC C/S Fx for ≥ 65

• Minimal Trauma

Fracture of the Axis: Dens

• What are the 3 types of Odontoid Fractures?

• Type 1:

  • Avulsion of the Hip

• Type 2:

  • At junction of dens on the body of the axis

• Type 3:

  • Below the junction of the dens

Fracture of the Axis: Dens

• Which of the 3 types of Odontoid Fx is the most difficult to heal?

  • Why?

• Type 2

  • Intact transverse and alar lig w poor bony contact

C/S: RA

• What is it?

• What does RA cause?

  • What 3 structures does it affect?

• What is it?

  • Erosion and narrowing of the facet jts

• Cause:

  • Increased Lig Laxity

    • Atlantoaxial Jt

    • Laxity of the Transverse Lig

    • Anterior Subluxation of C1 on C2

Lower C/S Fx: C3-C7

Fracture of C3-C7: Wedge Fx

• MOI:

  • 2

• Stable or Unstable Fx?

• MOI:

  • Hyper Flexion Injury

  • Ant Vertebral Compression of the vertebrae by adjacent vertebrae above and below

• Stable

Notice: Post Vertebrae Intact, Ant Vertebrae w Fx

Fracture of C3-C7: Burst Fx

• How does it occur?

  • 2

• Stable or Unstable Fx?

• How:

  • Axially loaded Intervertebral Disc compressed through the adjacent vertebrae

  • Bursting of the vertebrae w comminution

• Possibly Unstable

Fracture of C3-C7: Tear Drop Fx

• What is this fx known as?

• How does it occur?

  • 2

• Known as:

  • Most severe of the Lower C/S Fx (Hyper Flexion)

• How:

  • Separation of a piece of bone from the Anterioinferior border of the vertebral border

  • Hyperflexion or Hyperextension

Fracture of C3-C7: Tear Drop Fx

• How much force causes pieces to rupture off and tearing of post ligs.

• Stable or Unstable Injury

• Large Force

• Unstabble

Fracture of C3-C7: Clay Shoveler’s Fx

• What type of fx is this?

• MOI:

• What 3 segments does this fx MC occur?

• Stable or Unstable Fx?

• Type:

  • Avulsion fx of the Spinous Process (where Rhomboid or Traps attach)

• MOI:

  • Hyperflexion Force

  • Forceful contractions of the Trapezius or Rhomboids

Fracture of C3-C7: Clay Shoveler’s Fx

• What 3 segments does this fx MC occur?

• Stable or Unstable Fx?

• Common Pop:

• 3 Segments

  • C6, C7, T1

• Stable

• Pop:

  • Throwing Athletes

Dislocation of the C/S:

• Dislocation of the C/S usually occurs how? (3)

• Ligament rupture

• Dens Fx WITH ligament rupture

• Unstable Lower C/S

Dislocation of the C/S:

• Define:

  • Dens Fx WITH ligament rupture

    • Fx dislocation of what 2 segments?

  • Unstable Lower C/S

    • Fx combine w what?

    • __ __ Injury

• Dens Fx WITH ligament rupture

  • Fx dislocation occurs C1-C2

• Unstable Lower C/S

  • Tear of the Post Lig may cause anterior displacement

  • SC Injury

Dislocations w/o Fx:

• What are the 2 main types (in reference to the facet jts)

• Self-Reducing

• Complete

Dislocation w/o Fx:

• Self Reducing:

  • Define:

  • Transient __ or __

  • Do not appear on __

  • May have __ __ signs of injury

• Define:

  • Articulations are momentarily disengaged and then return to normal

• Transient dislocation or subluxation

• Radiographs

• Soft Tissue signs of Injury

Dislocation w/o Fx:

• Complete:

  • Define:

  • Can happen __ or __

• Define:

  • Inferior articulating process will lie in front of the superior process

• Unilateral or bilateral