Spinal fractures classification - Core Surgical Trainees' teaching
- 1. SPINAL FRACTURES Sheweidin Aziz – ST3 to Mr Basu CT teaching – Thursday 01/10/2015
- 2. AIM 1. Anatomy 2. Risk factors and causes 3. Assessment 4. Interpretation of C-spine X-Ray 5. Classification 6. Management
- 3. Anatomy
- 6. Risk factors • EVERYONE IS AT RISK • Age • Osteopososis • Ankylosing spondylitis • Malignancies
- 8. ASSESSMENT • AcBCDE • History • Physical Examination • Other injuries • Neurological assessment (ASIA chart) • Investigation (XR/CT/MRI)
- 9. INTERPRETATION OF C-SPINE X-RAY
- 14. 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?
- 15. CLASSFICATIONS
- 16. FRACTURES OF THE ATLAS Levine and Edwards A. 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
- 17. FRACTURES OF THE ODONTOID PROCESS (Dens) Anderson and D’Alonzo Type 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%)
- 18. 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.
- 19. 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.
- 20. OTA Classification Type A: Compression injuries of the body (compressive forces) • Type A1: Impaction • Type A2: Split • Type A3: Burst
- 21. 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)
- 22. 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)
- 23. 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
- 24. 4. Chance fracture 5. Flexion-distraction injury 6. Translational injuries
- 25. Management • Prevent secondary insult • Analgesia • Respiratory • GI protection • Prevent hypothermia • Bladder/Bowels • Joints • Bed sores • Psychological
- 26. QUESTIONS