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Chance Fracture

KEY FACTS Terminology Flexion-distraction injury, seat belt fracture Compression injury of anterior column with distraction of middle and posterior columns You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Fracture Dislocation

KEY FACTS Terminology Transversely applied force vector, resulting in shearing injury ± flexion &/or rotation You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Thoracic and Lumbar Burst Fracture

KEY FACTS Terminology Vertebral body fracture due to axial load, involving anterior & middle, ± posterior columns Anterior: Anterior longitudinal ligament, anterior 1/2 vertebral body, & anterior anulus fibrosis Middle: Posterior longitudinal ligament, posterior 1/2 vertebral body, & posterior anulus fibrosis Posterior: Neural arch, facet ligaments, ligamentum flavum, inter- & supraspinous ligaments You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy…

Apophyseal Ring Fracture

KEY FACTS Terminology Fracture or avulsion of vertebral ring apophysis following injury in immature skeleton You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Burst C2 Fracture

KEY FACTS Terminology Comminuted fracture through C2 vertebral body Displacement of fragments in AP direction You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Odontoid C2 Fracture

KEY FACTS Terminology Type I: Avulsion fracture from tip of odontoid at insertion of alar ligament Usually stable injury Usually seen in conjunction with more extensive craniocervical injury Type II: Transverse fracture through base of odontoid Most likely to progress to nonunion without surgical fusion Type III: Oblique fracture extending from base of odontoid into body of C2 Imaging Direct visualization of fracture line on radiography…

Atlantoaxial Rotatory Fixation

KEY FACTS Imaging Abnormal rotatory motion of C1 with respect to C2 defined by 3-position CT scan Top Differential Diagnoses Etiologies of atlantoaxial rotatory fixation (AARF) Trauma Nasopharyngeal infection (Grisel syndrome) Prior head and neck surgery Pathology Pang type I AARF : Unaltered or locked C1-C2 coupled configuration regardless of corrective counter-rotation Pang type II AARF : Reduced C1-C2 separation angle with forced correction but C1…

Jefferson C1 Fracture

KEY FACTS Terminology Fracture(s) of C1 ring Imaging Multiple fractures of C1 arch (2-, 3-, and 4-part fractures) Combined offset of lateral masses of C1 relative to lateral margins of C2 ≥ 7 mm suggests interruption of transverse ligament Avulsion fragment off inner C1 pillar at insertion of transverse ligament indicates unstable fracture Widening of atlantoaxial interval ≥ 4 mm concerning for interruption of transverse ligament…

Atlantooccipital Dislocation

KEY FACTS Terminology Disruption of stabilizing ligaments between occiput and C1 Imaging Widened prevertebral soft tissues (nonspecific) Condylar sum > 4.2 mm has 100% sensitivity, 69% specificity, and 76% accuracy Increased basion-dens interval (BDI) distance > 8.5 mm (CT in adults) Widened unilateral atlantooccipital interval > 2 mm Widened, fluid-filled facet joints between condyles and C1 STIR/T2WI MR best show ligamentous injury Top Differential Diagnoses Occipital…

Fracture Classification

Craniocervical Junction Occipital condyle fractures are classified into 3 types. Type I = comminuted fractures due to axial loading; stable if contralateral side is intact Type II = occipital condyle fracture with skull base fractures; most of these are stable Type III = avulsion fracture due to tensile force on alar ligaments; may show occipitocervical instability Recent data (Maserati 2009) suggests that initial evaluation should be…