0071643192.pdf

TRAUMA

TABLE 3.6. Stable Fractures of the C-Spine

TYPE MECHANISM NOTES

Wedge fracture Flexion Multiple wedge fxs or loss of

>50% of vertebral body height

may be unstable

Transverse process fracture Flexion

Clay shoveler’s fracture Flexion against contracted Most commonly at C7

(spinous process avulsion) posterior muscles

Unilateral facet Flexion and rotation Anterior displacement

< 50% of width

Burst fracture Vertical compression Can be unstable if fragments

enter canal

Isolated fractures of articular Vertical compression “Double-outline” sign

pillar and vertebral body

Markers of unstable C-spine

injury include damage to

anterior 20% of vertebral

body and loss of >50% of

body height.

TABLE 3.7. Major (Unstable) Thoracolumbar Spine Fractures

FRACTURE MECHANISM RADIOGRAPHICFINDINGS

Wedge compression fracture Flexion injury Loss of anterior vertebral body height

Neurologic deficit uncommon

Chance fracture Flexion around an anterior axis usually Horizontal fracture through the vertebral

associated with lap belt body and all posterior elements

Burst fracture Vertical compression Loss of anterior and posterior height

Flexion-distraction fracture Flexion with compression of anterior “Fanning”—increased posterior

elements and distraction of posterior interspinous space

elements

Translational fracture Shear Shift of one or more vertebral body causing

complete disruption

Anterior Cord Syndrome (Poor Prognosis)

■ Caused by flexion or extension with vascular injury of the anterior spinal

artery or bony fragment injury

■ Symptoms/exam: Include paralysis and loss of pain and temperature

sensationbut preserved position, crude touch, and vibration

Instability increases with

multicolumn injuries.