|
https://upload.orthobullets.com/topic/2018/images/flexion teardrop injury.jpg
https://upload.orthobullets.com/topic/2018/images/Xray-Lateral-Burst fracture_moved.jpg
https://upload.orthobullets.com/topic/2018/images/CT - Sagital - C5 burst fracture_moved.jpg
https://upload.orthobullets.com/topic/2018/images/extension teardrop.jpg
Introduction
  • Fracture patterns vary by mechanism and include
    • 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
    • posterior decompression, & fusion with instrumentation
      • indications
        • significant injury to posterior elements
        • anterior decompression not required
 

Please rate topic.

Average 3.1 of 24 Ratings

Questions (2)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
ARTICLES (11)
VIDEOS (1)
GROUPS (1)
Topic COMMENTS (14)
Private Note