0071643192.pdf

TRAUMA

Abnormal soft-tissue findings

on a lateral C-spine:

Remember 6 at 2 and 22 at 6,

and adjust up and down by

1 to get 7 mm and 21 mm.

■ CT scan should be obtained in all patients with abnormal or inadequate
C-spine X-rays or high clinical suspicion for injury.
■ Injuries are divided into unstable fractures (see Table 3.5 and Figures
3.5–3.8) and stable fractures (see Table 3.6) based on radiographic imaging.
■ If ligamentous injury is suspected and plain film and CT imaging is nega-
tive, MRI is indicated; flexion-extension views are limited by muscle
spasm and pain and therefore have little utility in the immediate post-
injury period.
■ Odontoid fractures are classified as:
■ Type I: Avulsion of the tip (stable)
■ Type II: Fracture at junction of odontoid and body of C2 (most common)
■ Type III: Fracture at base of dens

THORACOLUMBARFRACTURES

The thoracic spine (to approximately T11) is more rigid than the cervical and
lumbar spine due to its articulation with the rib cage but its canal is narrow.
Injury to the thoracic spine is therefore less common, but is often associated
with spinal cord injury.

SYMPTOMS/EXAM

■ Individuals with thoracolumbar fractures typically complain of pain in the
region of injury.
■ The exam varies with the fracture location and degree of associated spinal
cord injury.

Most common fracture

level is C5.

Most common subluxation

is C5 on C6.

TABLE 3.5. Unstable Fractures of the C-Spine

TYPE IMAGE MECHANISM CLINICALSTORY NOTES

Jefferson fracture Figure 3.5 Axial load with vertical Football player spearing Seen on odontoid view

(C1 burst fx) compression another player

Bilateral facet Figure 3.6 Flexion Although called locked Anterior displacement

dislocation facets the injury > 50% diameter of

is unstable vertebral body.

Odontoid type II/III Figure 3.7 Flexion Severe high cervical pain Usually due to major forces

or pain radiating to Consider other C-spine

the occiput and bodily injuries.

Atlantoaxial or Flexion or Atlanto-occipital

atlanto-occipital extension dissociation usually

dislocations results in death.

Hangman’s fracture Figure 3.8 Extension; C2 displaced Judicial hanging with Not common with

(bilateral C2 anteriorly on C3 ball of noose in front suicide hangings

pedicle fx)

Teardrop fracture Flexion or extension The teardrop is the

(an avulsion fracture) anteroinferior portion

of the vertebral body.