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Fractures Spine

Jefferson fx

Unstable, Ring fx of C1, lateral masses displacement > 2 mm, transverse ligament rupture, compression (diving); halo x 3 months

Dens fx

Anterior tilt on lateral view; prevertebral ST swelling, os odontoideum; predental space 3 mm (kids 4-5 mm)

Burst fx

C3-C7, fx fragments into canal - retropulsion, stable unless > 25% of compression

Atlanto-Occipital Dislocation

Unstable, Down Syndrome, prevertebral ST swelling, distance from basion (tip of clivus) to the posterior ring of C1, and distance from opisthion to the anterior ring of C1

Hangman's fx

Unstable, Bilateral pedicle or pars interarticularis fx of C2, hyperextension (hanging, chin on dashboard w/o seatbelt), best seen on lateral view, anterior dislocation of C2, prevertebral ST swelling

Flexion Teardrop fx

Unstable, most severe C-spine injury, C6, C7 levels, ligamentous injury, acute anterior cord syndrome - permanent quadruplegia, teardrop fragment, posterior subluxation of vertebral body, bilateral dislocated facets, spinal process fx, severe compromise of spinal canal, vertebral artery injury

Wedge Compression fx

MRI T2 fat-sat, anterior wedging > 3mm, posterior cortex intact

Bilateral Facet Locks/Dislocation

Unstable, anterior dislocation>50%, all ligaments injured (anterior, posterior, flavum, interspinous); locked --> perched --> subluxated

Unilateral Facet Locks

Stable, < 50% anterior dislocation from simultaneous flexion and rotation, perched, bow-ties, bat-wing appearance

Anterior subluxation

Posterior ligament disruption, widened interspinous distance (fanning)

Extension Teardrop fx

Stable, teardrop fragment from hyperextension

Clay-shoveler's fx

Avulsion fx of C7 spinous process from powerful hyperflexion; if C6, C7 not seen, obtain swimmers view

Chance fx

Lap seatbelt fx, L2, L3, horizontal split of vertebrae, spinous process and intervertebral disk, rupture of ligaments