skel rad 3

a fractuure which both cortices of bone have been disrupted.

• a fracture that involves only one cortex of bone
• commone in kids

• incomplete fracture of the long bones of extremities
• seen only in kids
• bone bows out so you know theres a fracture but you can't see it

• incomplete fracture of the long bones of extremitiesseen only in kids
• bulge (looks like a roman pillar) it's typticaly only in one spot
• because of that you have to look at all views
• primary location is distal radius

• "simple"
• factures is covered by intact skin

muscle rips off the bone

• "compound"
• is not covered by intact skin
• there is communication between the fracture and the outside enviornment
• it is suscepticble to infection (toes and fingers)

fracture that has more than 2 fracture fragments

• in long bones
• suggestive of pathology

common in long bones

more common in small bones

• suggests a rotatiional mechanism of injury
• if see clean fratures in multiple views

avulsed, impacted and distracted

• a ligamentous of tendinous insertion site
• the frament is pulled away fromt he parent bone

• forces produce a compression of bone
• impaction of trabeculae on each other
• look for a white zone of condensation

fracture framents areheld apart by interposed soft tissues or muscle pull

how are the 2 fracture ends doing? do the need to be pinned or are they alligned?

typically let kids be even if bad apposition bc the bones will still grow back together

• fatigue fracture
• insufficiency fracture

they creep up on you ie. from running

• a fracture produced by abnormal stress of NORMAL bone
• athletes

a fracture produced by normal stress on ABNORMAL bone ie. osteoporosis

comminuted fracure of a vertebral body produced by an axial load on a neutral spine

fracture fragments displace anteriorly and posteriorly

UNSTABLE

associated with injury to the spinal cord

• T1- fat bright
• T2 - H2O bright

for fractures get a ster image b/c fracture will light up

• assessed with spinal injuries
• potential for injury to the spinal cord
• many different differing opinions
• if unstable you'll probably need to refer out

• anterior: ALL and ant 2/3 of vert body and disc
• middle: PLL and post 1/3 body and disc
• posterior: post arch and ligaments (pedicle, TPs, laminae, articular facets, SPs)

injuries involving one column are likely to be stable

injuries involving 2 or 3 are likely to be unstable and will likely result in neurologic injury

• dens
• SP
• bilat facet dislocation

wedge teardrop

• jefferson's
• burst

• SP
• hyperextention fracture/dislocation

dens

hangman's

unilat facet dislocation

facet

• facet
• lamina

• lat wedge body fracture
• facet

• lat wedge body fracture
• facet

• ant elements destroyed - 2 pts
• post elements destroyed - 2 pts
• a/p translation > 3.5 mm- 2 pts
• flex/ext >11 degreees between levels - 2 pts
• cord damage - 2 pts
• root damage - 1 pt
• abnormal disc narrowing - 1 pt
• dangerous loading anticipated - 1 pt

5+ pts = unstable

flex and ext views are used for a lot of them

designed by white

the big ones are the A/P translation and flex/ext >11 degrees

• use georges line
• if > 3.5 dr. major considers in unstable no matter what
• adding up flex and ext views need to be <3.5

6@2 - check at c2 shouldnt exceed 6mm

• 22@6
• at C6 shouldn't exceed 22 in adult
• and 14 in kids

• parallels the ant longitudinal lig to C6
• can be displaced by edema and hemorrhage

• secondary to muscle spasm
• hard b/c don't know what pat looked like before

indicates ligametous disruption (nucal and interspinal lig)

will be seen with facet subluxations and disloc

• muscle spasm
• antlant-axial rotary fixations
• nilateral facet dislocation

at each level the interspinous distance should not exceed 1.5 times the levels aboce and below

measure from base of the SP not tip

will see double contour of the post vert bodies

• upper limits of normal
• 3mm for adults
• 5mm for kids

if increased= may gape with flex/ext injuries

less common than dens fractures due to strength of transverse lig

produced by head injury

differentially diagnose from v-shaped ADI wich is noral variant

evaluate spinolaminar junction line ( lower limit of normal for central canal at C1 is 16)

Targs = 80% of vert body diameter

• A-P dameter
• C-16
• C2-14
• C3-13
• C4-12

unknown etiolgoy- may be due to laxity of capsular structures, alar and transverse lig

may occur following upper respiratory tract infection or trauma

patient presents with torticollis (unlike normal tort the mm spasm is onthe long SCM side)

rot views with opten mouth and CT scans

treatemtn: traction or maybe surgery

R lat mass larger means L rot

• MC fracture of C1 but still not common
• MOI is axial compression and hyperextenssion
• Fracture occus through sulsuc for vertebral artery
• opten associated with SP fracture in the lower cervical spine

• burst fracture of C1
• MOI is axial compression
• Best visualized on the APOM view-appears as offset of the lateral masses of C1-C2
• over 8 mm of offset indicated tearing of the transverse lig
• *if C1 lat mass more lat then C2
• don't confuse with "pseudo-jefferson's fract" in kids
• arounf 4 yrs old atlas grows faster than axis -prod offset of lat masses on the APOM view
• axis catches up around 10

• rare
• MOI lat compression

• MOI: ant frct/disloc = hyperflex
• post fract/disloc = hyperext
• lat displacement = lat flex\

• S&S may be mild
• oblique views may help
• diff diag: physiologic post tilt of dens, mach bands, ossiculum terminaale (type 1), os odontoideum (type 2), normal synchondrosis in kids

• Type 1= fract of the apex of dens, rare, stable, oblique
• Type 2= fract throughthebase of dens, MC, unstable
• Type 3= fract extends into body (cancellous bone) of C2, unstable

get MRI w/ all of them

• considered by many to represent an old, ununited frature of the odontoid process
• must be assessed for stability
• if see not from an acute fracture
• could be congenital?

• bilat fract through lat pars interarticularis
• *traumatic spondyolisthesis of C1 & C2
• MOI is hyperextension
• often seen as a result of car accident when head hits windshield
• can be through pedicles as well
• can even go through body of C1 and C2

• Rare at C2
• ununited SP apphysis may mimic a fracture
• if secondary growth ceneter it would be inline with main pies of bone
• if old fracture- displaced from line of main piece of bone

• MOI = hyper flexion
• appear as fracture of ant vert body margin
• often confused with normal cariants or DDD
• post cert body height has t be pretty unchacned for compression fracture
• if it is decreased means burst fracture

• intercalary bone
• developmental platyspondylyl
• normal cert body apophysis

• comminuted fracture of the vert body
• MOI axial compression on neutral spine
• risk of neuro deficit from post projected framents
• post and and aspect body involved
• unstable b'/c damage to 2 columns

white

only ant vert body affected and smooshed

• MC loc for fractures in cervical spine
• account for 50%of cerv spine fract

• MC POST ARCH FRACT
• most at C5-C6
• hyperextension
• focal pain over an art pillar

CT would allow for definitive and get CT if pat arent responding to conservative care or who show neuro deficit