Spinal fractures classification - Core Surgical Trainees' teaching
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Transcript of Spinal fractures classification - Core Surgical Trainees' teaching
SPINAL FRACTURES
Sheweidin Aziz – ST3 to Mr Basu CT teaching – Thursday 01/10/2015
AIM1. Anatomy
2. Risk factors and causes
3. Assessment
4. Interpretation of C-spine X-Ray
5. Classification
6. Management
Anatomy
Risk factors• EVERYONE IS AT RISK
• Age
• Osteopososis
• Ankylosing spondylitis
• Malignancies
ASSESSMENT• AcBCDE
• History
• Physical Examination• Other injuries • Neurological assessment (ASIA chart)
• Investigation (XR/CT/MRI)
INTERPRETATION OF C-SPINE X-RAY
What is next?• Are the images adequate?
• Are there other conditions making it difficult to read plain radiographs?
• What is ikely injury? Bony? Ligamentous?
• Is further imaging required? CT? MRI?
CLASSFICATIONS
FRACTURES OF THE ATLASLevine and EdwardsA. Transverse process fracture: Avulsion injury
B. Posterior arch fractures: Hyperextension injury associated with axis fractures
C. Anterior arch fractures: Hyperextension injury
D. Comminuted fractures/Lateral mass fractures: Axial Load and lateral bending injury
E. Burst Fracture (Jefferson Fracture): Axial load injury
FRACTURES OF THE ODONTOID PROCESS (Dens)Anderson and D’AlonzoType I: Oblique avulsion fracture of the apex (5%)
Type II: Fracture at the junction of the body and the neck; high non-union rate (60%)
Type III: Fracture extends into the body of C2 and may involve the lateral facets (30%)
TRAUMATIC SPONDYLOLISTHESIS OF AXIS
Levine and Edwards
Type I: Minimally displaced with no angulation; translation <3mm; stable.
Type II: Significant angulation; translation >3mm; unstable C2–C3 disc disrupted. Subdivided into Flexion/extension/listhetic types.
TRAUMATIC SPONDYLOLISTHESIS OF AXIS
Type IIA: Avulsion of entire intervertebral disc in flexion, ALL intact. Severe angulation. No translation; unstable due to flexion-distraction injury.
Type III: Rare. Initial anterior facet dislocation of followed by extension injury fracturing the neural arch. Severe angulation and translation with unilateral or bilateral facet dislocation. Unstable.
OTA ClassificationType A: Compression injuries of the body (compressive forces)
• Type A1: Impaction
• Type A2: Split
• Type A3: Burst
Type B: Distraction injuries of the anterior and posterior elements (tensile forces)
• Type B1: Posterior. Predominantly ligamentous
• Type B2: Posterior: Predominantly osseous (flexion-distraction injury)
• Type B3: Anterior disruption through the disc (hyperextension-shear injury)
Type C: Multidirectional injuries with translation affecting the anterior and posterior elements
• Type C1: Rotational wedge, split, and burst fractures
• Type C2: Flexion subluxation with rotation
• Type C3: Rotational shear injuries (Holdsworth slice rotation fracture)
FRACTURES THORACOLUMBAR SPINE• McAfee: based on the failure mode of the middle osteo-
ligamentous complex (PLL, posterior ½ vertebral body and posterior annulus fibrosus)
1. Wedge-compression fracture
2. Stable burst fracture
3. Unstable burst fracture
4. Chance fracture
5. Flexion-distraction injury
6. Translational injuries
Management • Prevent secondary insult• Analgesia• Respiratory• GI protection• Prevent hypothermia• Bladder/Bowels• Joints• Bed sores• Psychological
QUESTIONS