Spinal Fractures.pptx

Spinal injury

1. Spinal Fractures

2. Morphology C halk stick fracture S pinal compression fracture burst fracture wedge fracture vertebra plana  ( mnemonic ) Fractures by location cervical spine fracture dens fracture extension teardrop fracture ​flexion teardrop fracture hangman fracture Jefferson fracture clay- shoveler's fracture thoracolumbar spine fracture Chance fracture transverse process fracture spondylolysis limbus fractures sacral fracture sacral insufficiency fractures

3. Chalk stick , also known as  carrot stick fractures , are fractures of the fused spine, classically seen in  ankylosing spondylitis Chalk stick fractures are most commonly encountered in  ankylosing spondylitis  but may also been seen in the fused spines in patients with  2 : diffuse idiopathic skeletal hyperostosis ossification of the ligamentum flavum ossification of the posterior longitudinal ligament surgical spinal fusion

4. Spinal compression fracture Spinal compression fractures  occur as a result of injury, commonly fall onto the buttock or pressure from normal activities, to the weakened vertebrae due to  osteoporosis . The vertebral fracture should be diagnosed when there is a loss of height in the anterior, middle, or posterior dimension of the vertebral body that exceeds 20%. Genant classification of vertebral fractures  based on vertebral height loss as: mild: up to 20-25% moderate: 25-40%  severe: >40%

5. Burst fracture Burst fractures  are a type of compression fracture related to high-energy axial loading spinal trauma that results in disruption of a vertebral body endplate and the posterior vertebral body cortex. Retropulsion of posterior cortex fragments into the spinal canal is frequently included in the definition.  loss of vertebral height on lateral views: anterior portion is commonly compressed more than the posterior portion of the vertebral body fracture always involves the posterior vertebral body cortex burst vertebral body on axial CT vertical fracture through the posterior elements is usually present in more severe trauma interpedicular widening bone fragment retropulsion into the spinal canal may occur consequent  spinal cord contusion  may occur, and it is best assessed by MRI (axial and sagittal T2)

6. Wedge fracture Spinal wedge (compression) fractures  are hyperflexion injuries to the  vertebral body  resulting from axial loading. Radiographs, CT, and MRI may show cortical disruption with impaction of one endplate without the involvement of the posterior wall  6 . This results in the characteristic "wedged" appearance

7. Vertebra plana Vertebra plana  (plural: vertebrae planae ), also known as the  pancake ,  silver dollar  or  coin-on-edge vertebra ,   is the term given when a vertebral body has lost almost its entire height anteriorly and posteriorly, representing a very advanced compression fracture

8. F ractures by location cervical spine fracture dens fracture extension teardrop fracture ​ flexion teardrop fracture hangman fracture Jefferson fracture clay-shoveler's fracture thoracolumbar spine fracture Chance fracture transverse process fracture spondylolysis limbus fractures sacral fracture sacral insufficiency fractures

9. F ractures by location cervical spine fracture dens fracture extension teardrop fracture ​ flexion teardrop fracture hangman fracture Jefferson fracture clay-shoveler's fracture

10. Odontoid fracture Odontoid process fracture ,   also known as a  peg  or  dens fracture , occurs where there is a fracture through the odontoid process of  C2 . Classification Anderson and D'Alonzo type I rare fracture of the upper part of the odontoid peg (generally oblique) above the level of the transverse band of the  cruciform ligament usually considered stable type II most common transverse course fracture at the base of the odontoid below the level of the transverse band of the  cruciform ligament unstable high risk of non-union type IIa ​type II fractures with comminution at the odontoid base Hadley  2  described this type of fracture which has a significantly increased risk of nonunion when treated non-operatively compared with classical type II fractures represents 5-10% of type II fractures type III through the odontoid and into the lateral masses of C2 relatively stable if not excessively displaced best prognosis for healing because of the larger surface area of the fracture

11. Extension teardrop fracture Extension teardrop fracture  typically occurs due to forced extension of the neck with resulting avulsion of the anteroinferior corner of the vertebral body anterior-inferior corner fracture  3 avulsion fracture from the attachment of the anterior longitudinal ligament to the inferior corner of the vertebral body, usually a thin fracture fragment the fragment is triangular in a shape reminiscent of a teardrop vertical height of fragment is equal to or greater than width anterior disc space widening

12. Flexion teardrop fracture Flexion teardrop fractures  represent a fracture pattern occurring in severe axial/flexion injury of the cervical spine.  Flexion teardrop fractures most commonly occur at the mid/lower cervical spine, specifically at C4, C5, or C6  1,2 . The most characteristic findings include: fracture of the anteroinferior lip of vertebral body classically a triangular fragment (teardrop sign) larger fragments may not appear triangular anterior fragment often minimally displaced posterior displacement of the posterior vertebral body relative to the intact inferior cervical column evidence of posterior ligamentous rupture

13. Hangman fracture Hangman fracture , also known as  traumatic spondylolisthesis of the axis , is a fracture which involves the  pars interarticularis  of  C2  on both sides, and is a result of hyperextension and distraction. Radiography and CT demonstrate the findings: typical: bilateral C2 pars interarticularis fractures atypical variant: one or both sides of C2 has a coronal plane (vertically oriented) fracture through the posterior vertebral body instead of the pars interarticularis possible alignment abnormality:  anterolisthesis  of C2 on C3 or angulation Extension of the fracture to the  transverse foramina  should be sought, raising the possibility of  vertebral artery  injury.

14. Jefferson fracture Jefferson fracture  is the eponymous name given to a  burst fracture  of the  atlas . It was originally described as a four-part fracture with double fractures through the anterior and posterior arches, Radiographs will show asymmetry in the  odontoid view  with the displacement of the lateral mass(es) away from the odontoid peg (dens). A distance of greater than 6 mm suggests ligamentous injury.

15. Jefferson fracture type 1:  fractures of the anterior arch type 2:  fractures of the posterior arch and are usually bilateral type 3:  fractures involving the anterior and posterior arch ( Jefferson burst fracture ) type 3a:  intact transverse atlantal ligament type 3b:  disrupted transverse atlantal ligament complex Dickman type 1:  ligamentous disruption Dickman type 2:  bony avulsion with an intact transverse atlantal ligament type 4:  fractures of the lateral mass type 5:  isolated fractures of the C1 transverse process

16. Clay-shoveler fracture Clay-shoveler fractures  are fractures of the spinous process of a lower cervical vertebra. The fracture is seen on lateral radiographs as an oblique lucency through the spinous process, usually of C7. There is usually significant displacement.

17. Fractures by location thoracolumbar spine fracture Chance fracture transverse process fracture spondylolysis limbus fractures

18. Chance fracture Chance fractures  also referred to as  seatbelt fractures ,   are flexion-distraction type injuries of the spine that extend to involve all  three spinal columns . These are unstable injuries and have a high association with intra-abdominal injuries. Anterior wedge fracture of the vertebral body with a horizontal fracture through posterior elements or distraction of facet joints and spinous processes. empty vertebral body sign : can be seen on an AP radiograph and results from the vertical separation of the posterior elements displacing the spinous processes or spinous process fracture fragments of the vertebral body on the AP projection transverse fractures across the transverse processes, laminae, and articular processes widening of the interpedicular distance : often suggests a burst component widening of the facet joints  and  increased intercostal spacing widening of the interspinous spaces

19. Transverse process fracture Transverse process fractures  are common sequelae of trauma, although they are considered minor and stable  lumbar spine fractures . Transverse process fracture most commonly occurs in the upper  lumbar spine  and are commonly multiple  2 . The fracture line can extend into the  transverse foramen , and in the cervical spine, there is a risk of complicating  vertebral artery dissection .

20. Spondylolysis Spondylolysis  is a defect in the  pars interarticularis  of the neural arch, the portion of the neural arch that connects the superior and inferior articular facets. It is commonly known as  pars interarticularis defect  or more simply as  pars defect .  Scotty dog sign : on oblique radiographs, a break in the pars interarticularis can have the appearance of a collar around the dog's neck inverted Napoleon hat sign

21. Posterior ring apophyseal fracture Posterior ring apophyseal fracture  or  separation , also called  limbus fracture , occur in the immature skeleton, most commonly in the lumbar spine. They represent bony fractures of the vertebral body rim at the site of attachment of the Sharpey fibers of the  intervertebral disc . They can be classified as follows: type I : avulsions of the posterior cortical vertebral rim type II : central cortical and  cancellous bone  fractures type III : lateralized chip fractures type IV : span the entire length and breadth of the posterior vertebral margin between the endplates CT CT is excellent for bony detail and is therefore usually the first line imaging modality. Findings include: osseous fragment displaced posteriorly to endplate with rectangular or arc-shaped morphology on axial plane posterior endplate defect posterior  disc herniation

22. S acral fracture sacral insufficiency fractures

23. Sacral insufficiency fracture Sacral insufficiency fractures  are a subtype of  stress fractures , which are the result of normal stresses on abnormal bone, most frequently seen in the setting of  osteoporosis . They fall under the broader group of  pelvic insufficiency fractures . Plain radiograph They may be normal, or a sclerotic line may be noted in the involved region(s). CT May show a fracture line along with sclerosis that is parallel to the sacroiliac joint, although even CT imaging is less sensitive as compared to MRI and nuclear imaging. MRI Can depict bone marrow edema as early as 18 days after the development of symptoms

24. Le Fort fracture classification Le Fort fractures  are fractures of the midface, which collectively involve separation of all or a portion of the midface from the  skull base . Le Fort type I horizontal  maxillary  fracture, separating the  teeth  from the upper face fracture line passes through the alveolar ridge, lateral nose and inferior wall of the  maxillary sinus also known as a Guerin fracture Le Fort type II pyramidal fracture, with the teeth at the pyramid base, and nasofrontal suture at its apex fracture arch passes through the posterior alveolar ridge, lateral walls of maxillary sinuses,  inferior orbital rim  and  nasal bones uppermost fracture line can pass through the nasofrontal junction or the frontal process of the maxilla  3 Le Fort type III craniofacial disjunction transverse fracture line passes through  nasofrontal suture ,  maxillo-frontal suture ,  orbital wall , and  zygomatic arch / zygomaticofrontal suture because of the involvement of the zygomatic arch, there is a risk of the  temporalis  muscle impingement unsurprisingly type III fractures have the highest rate of CSF leak

25. 1 Column - Anterior compression injury Anterior compression injury is a common fracture pattern which results from traumatic hyper-flexion with compression. Although considered 'stable' the greater the loss of height anteriorly the greater the risk of middle column involvement. X-ray may underestimate the extent of injury and so if there has been high risk injury or other suspicion of instability then CT should be considered.

26. 2 column - 'Burst' fracture 'Burst' fractures result from high force vertical compression trauma. Posterior displacement of vertebral body fracture fragments into the spinal canal leads to a high risk of spinal cord or nerve root damage.