Difference between revisions of "Unstable spine fractures"

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(Examples of Unstable Fractures)
 
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==Background==
 
==Background==
[[File:Three-column-concept-2.jpg]]
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[[File:Three-column-concept-2.jpg|thumb]]
 
Denis' three column concept helps to determine whether a vertebral fracture is stable or unstable
 
Denis' three column concept helps to determine whether a vertebral fracture is stable or unstable
 
*I: Anterior column
 
*I: Anterior column
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**Ligament flavum
 
**Ligament flavum
 
**Posterior elements
 
**Posterior elements
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===Examples of Unstable Cervical Spine Fractures===
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*[[Jefferson's fracture]]
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*Bilateral [[Cervical facet dislocation]]
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*[[Odontoid fracture]], type II or III
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*[[Atlanto-occipital dissociation]]
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*[[Hangman's fracture]]
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*[[Flexion teardrop]]
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*''Mnemonic: "Jefferson Bit Off A Hangman's Thumb"''
  
 
==Clinical Features==
 
==Clinical Features==
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*III:Always unstable
 
*III:Always unstable
  
==Example of Unstable Fractures==
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==Evaluation==
*Jefferson's fracture
 
*Bilateral facet dislocation
 
*Odontoid type II or III
 
*Any fracture and dislocation (atlanto-axial or atlanto-occiptial)
 
*Hangman's fracture
 
*Flexion teardrop
 
 
 
==Workup==
 
 
*CT with reconstructions
 
*CT with reconstructions
*Consider plain x-ray in conjunction as this is what is used during orthospine f/u
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*Consider plain x-ray in conjunction as this is what is used during orthospine follow up
 
*MRI to assess cord and ligament damage
 
*MRI to assess cord and ligament damage
  
 
==Management==
 
==Management==
*C-collar
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{{Unstable cervical spine fracture management}}
*Consult ortho or spine as needed
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==Disposition==
  
 
==See Also==
 
==See Also==
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*[[Fractures (Main)]]
 
*[[Fractures (Main)]]
  
==Sources==
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==References==
 
<references/>
 
<references/>
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[[Category:Trauma]]
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[[Category:Neurology]]
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[[Category:Orthopedics]]

Latest revision as of 13:41, 23 August 2017

Background

Three-column-concept-2.jpg

Denis' three column concept helps to determine whether a vertebral fracture is stable or unstable

  • I: Anterior column
    • Anterior longitudinal ligament
    • Anterior 1/2 of the vertebral body and disk
  • II: Middle column
    • Posterior 1/2 of the vertebral body and disk
    • Posterior longitudinal ligament
  • III: Posterior column
    • Facet joints
    • Ligament flavum
    • Posterior elements

Examples of Unstable Cervical Spine Fractures

Clinical Features

  • I:Always stable
  • II:Possibly unstable
  • III:Always unstable

Evaluation

  • CT with reconstructions
  • Consider plain x-ray in conjunction as this is what is used during orthospine follow up
  • MRI to assess cord and ligament damage

Management

  • C-collar
  • Consult ortho or spine as needed

Disposition

See Also

References