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A Gallie C1-2 fusion with sublaminar wiring of C1 to the spinous process of C2 is a valid treatment option for which of the following injury patterns?
comminuted C1 burst fracture
type I odontoid fracture
type III odontoid fracture
transverse ligament disruption
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Biomechanical studies have shown that an atlanto-dens interval of >7mm is likely associated with?
an intact transverse ligament, with ruptured alar and apical ligaments
a ruptured transverse ligament, with intact alar and apical ligaments
a ruptured transverse and apical ligament, with an intact alar ligaments
a ruptured transverse and alar ligament, with an intact apical ligaments
a ruptured transverse and alar ligament, and a ruptured tectorial membrane
A 35-year-old patient sustains a bilateral anterior and posterior arch (C1) injury with an intact transverse ligament. Which of the following treatment options is most appropriate?
Soft collar orthosis for 4-6 weeks
Rigid collar orthosis for 6-12 weeks
Posterior C1-C2 fusion
Figure A shows the coronal and axial CT images of a 27-year-old male that suffered a fall from a significant height. Which of the following radiographic measurements would best indicate disruption of the transverse ligament?
Atlantodental interval (ADI) of 2mm
Posterior atlanto-dens interval (PADI) of 16mm
C2 pars horizontal displacement of 3 mm
Combined lateral mass displacement of 8.2mm
A Power's ratio of 1.2
HPI - Patient was riding a motor bike in South East Asia when a car pulled out in front. Patient then swerved to miss the car and ended up going head first into a metal pole on the side of the road. He was wearing a helmet and traveling at 40 km/hr.
At hospital MRI showed no ligament damage but CT showed fracture of the right anterior arch and left posterior arch right behind the left lateral mass. CT also showed a clay shovelers fracture attributed to the patient holding on tightly to the handlebars. The patient was then airlifted to Singapore.
Time frame and Planning:
Week 1: Fitted with halo (discharged from hospital after 10 days)
Week 8: Halo removed Aspen Vista applied, no union
Week 12: New Scans, no improvement, gap widened.
Week 14: Soft Collar used during sleeping and on and off during day.
Week 16: Sleeping without brace, no brace for 50% of day. Return to work part time
Week 18: No brace.
Week 22: Return to work full time.
Currently the patient is a
Many patients have non-union. Is this a cause for concern?
HPI - The patient is 43 year old gentleman, who was assaulted and placed in a head lock 2 months ago. He said he heard something "crack" in his neck. He immediately had severe neck pain, and difficulty swallowing over the first few days, but denied any weakness. Over the following weeks he developed weakness in his upper and lower extremities that evolved to the point that he lost his ability to ambulate, and was admitted to the public hospital in Managua, Nicaragua.
How would you treat this patients? Keep in mind we are in Nicaragua, and there are very few implants available.