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Updated: Dec 19 2023

Subaxial Cervical Vertebral Body Fractures

Images
https://upload.orthobullets.com/topic/2018/images/flexion teardrop injury.jpg
  • Summary
    • Subaxial Cervical Vertebral Body Fractures are a subset of cervical spine injuries that consist of compression fractures, burst fractures, flexion teardrop fractures, and extension teardrop avulsion fractures.
    • Diagnosis is made with radiographs of the cervical spine. CT scan can be helpful for fracture characterization and surgical planning. 
    • Treatment can be nonoperative or surgical stabilization depending on fracture pattern, mechanical stability, and the presence of neurological deficits. 
  • Etiology
    • Types
      • compression fracture
        • characterized by
          • compressive failure of anterior vertebral body without disruption of posterior body cortex and without retropulsion into canal
          • often associated with posterior ligamentous injury
      • burst fracture
        • characterized by
          • fracture extension through posterior cortex with retropulsion into the spinal canal
          • often associated with posterior ligamentous injury
        • prognosis
          • often associated with complete and incompete spinal cord injury
        • treatment
          • unstable and usually requires surgery
      • flexion teardrop fracture
        • characterized by
          • anterior column failure in flexion/compression
            • posterior portion of vertebra retropulsed posteriorly
          • posterior column failure in tension
          • larger anterior lip fragments may be called 'quadrangular fractures'
        • prognosis
          • associated with SCI
        • treatment
          • unstable and usually requires surgery
      • extension teardrop avulsion fracture
        • characterized by
          • small fleck of bone is avulsed of anterior endplate
            • usually occur at C2
            • must differentiate from a true teardrop fracture
        • mechanism
          • extension
        • prognosis
          • stable injury pattern and not associated with SCI
        • treatment
          • cervical collar
  • Subaxial Spine Injury Classification
    • Allen and Ferguson classification(of subaxial spine injuries)
      • typically used for research and not in clinical setting
      • based solely on static radiographs appearance and mechanisms of injury
      • six groups represent a spectrum of anatomic disruption and include
        1. flexion-compression
        2. vertical compression
        3. flexion-distraction
        4. extension-compression
        5. extension-distraction
        6. lateral flexion
    • Radiographic description classification (of subaxial spine injuries)
      • more commonly used in clinical setting
      • includes
        • compression fracture
        • burst fraction
        • flexion-distraction injury
        • facet dislocation (unilateral or bilateral)
        • facet fracture
  • Presentation
    • Symtoms
      • incomplete vs. complete cord injury
  • Imaging
    • Must determine if there is a posterior ligamentous injury so MRI often important
  • Treatment
    • Nonoperative
      • collar immobilization for 6 to 12 weeks
        • indications
          • stable mild compression fractures (intact posterior ligaments & no significant kyphosis)
          • anterior teardrop avulsion fracture
      • external halo immobilization
        • indications
          • only if stable fracture pattern (intact posterior ligaments & no significant kyphosis)
    • Operative
      • anterior decompression, corpectomy, strut graft, & fusion with instrumentation
        • indications
          • compression fracture with 11 degrees of angulation or 25% loss of vertebral body height
          • unstable burst fracture with cord compression
          • unstable tear-drop fracture with cord compression 
          • minimal injury to posterior elements
        • early decompression (< 24 hours) has been shown to improve neurologic outcomes compared with delayed (>/ 24 hours) decompression
      • posterior decompression, & fusion with instrumentation
        • indications
          • significant injury to posterior elements
          • anterior decompression not required
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Question
1 of 3
In scope icon N/A
QID 219789 (Type "219789" in App Search)
A 71-year-old female presents to the clinic with complaints of left thigh start-up pain. She originally had a left total hip arthroplasty performed by an outside surgeon 10 years ago. A current radiograph is shown in Figure A. She is diagnosed with aseptic loosening of the femoral component. After a negative infectious workup, she is indicated for a revision total hip arthroplasty. Intraoperatively, the surgeon plans to perform an extended trochanteric osteotomy to facilitate the removal of the current implant and the cement mantle. The surgeon is concerned with proximal migration of the osteotomy fragment. What surgical technique can help mitigate the risk of proximal trochanteric migration?
  • A

Abduction of the hip 25-30 degrees during trochanteric reduction and fixation

22%

143/652

Limiting the osteotomy length to less than 10 cm

7%

45/652

Placing a cerclage cable distal to the planned osteotomy site

8%

51/652

Supplementing fixation with cortical strut allograft

4%

26/652

Utilizing plate fixation in addition to cerclage cables

58%

376/652

  • A

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Spine | Subaxial Cervical Vertebral Body Fractures
  • Spine
  • - Subaxial Cervical Vertebral Body Fractures
12:21 min
7/13/2022
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