0071643192.pdf

TRAUMA

FIGURE 3.7. Odon-

toid fractures.

(Reproduced, with permis-

sion, from Tintinalli JE,

Kelen GD, Stapczynski JS.

Emergency Medicine:A

Comprehensive Study

Guide, 6th ed. New York:

McGraw-Hill, 2004:1704.)

FIGURE 3.8. Hangman’s fracture.

(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS.Emergency
Medicine:A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:1707.)

Unstable C-spine

fractures—

Jefferson Bit Off A

Hangman’s Thumb

Jefferson fracture

Bilateral facet dislocation

Odontoid type II/III

Atlantoaxial or atlanto-

occipital dislocations

Hangman’s fracture

Teardrop fracture

DIAGNOSIS

■ Suspect based on clinical presentation and/or plain radiographs
■ CT scan is confirmative and can fully define the injury.
■ Injuries are divided into major fractures (see Table 3.7) and minor fractures
(transverse process, spinous process, and pars interarticularis) based on
radiographic imaging.

Spinal Cord Injuries

Spinal cord injuries may be complete (total loss of function below lesion) or
incomplete.

INCOMPLETESPINALCORDINJURIES

The most common incomplete lesions include:

■ Central cord syndrome
■ Brown-Séquard syndrome
■ Anterior cord syndrome

Central Cord Syndrome (Fair Prognosis)

■ The most common incomplete spinal cord lesion
■ Caused by a hyperextension injury on a congenitally narrow cord or pre-
existing cervical spondylosis (older patients), resulting in buckling of the
ligamentus flavum and compression of the central cord.
■ Symptoms/exam:Weakness and numbness greater in the arms than the
legs(patients may have complete quadriplegia); bowel and bladder control
remain in all but the most severe cases.
■ Although function usually returns, most patients do not regain fine motor
control in upper extremities.