5.9 E) Viii) Orthopaedics Fractures Spine

Front 1

Which is incorrect regarding cervical spine injuries?
1. oblique views of the cervical spine provide better visualisation of the facet joints
2. The mechanism for unilateral facet joint dislocations is usually flexion-rotation.
3. Vertical compression is the mechanism for burst fractures
4. Jefferson fractures are "blowout" fractures of the ring of the Atlas-C1
5. The main mechanism of injury for C1 fractures is hyperflexion.

Back 1

5. hyperextension OR compression

Front 2

Which is incorrect regarding cervical spine injuries?
1. Fractures of the atlas comprise 4% of cervical spine injuries
2. Fractures of the axis comprise 10% of all cervical spine injuries.
3. The majority of C2, axis injuries , are associated with concurrent C1 injuries.
4. 15-20% of Atlas injuries are associated with a C2 injury.
5. 25% of atlas injuries are associated with lower cervical injury.

Back 2

2. 6%

Front 3

which is incorrect regarding cervical spine injuries?
1. The main type of odontoid fracture is Type 2
2. Type 1 odontoid fractures are avulsion of the odontoid tip.
3. Type 2 odontoid fractures are unstable.
4. Type 3 fractures of the odontoid extend into the vertebral body, and comprise 45% of odontoid fractures
5. Type 1-3 odontoid fractures have the following frequency rates, in order of type: 5-8% , 55-70% , and 30-35%.

Back 3

4. 30-35%

Front 4

Which is incorrect regarding cervical spine injuries?
1. The Jefferson fracture is a blow-out fracture of C1
2. The Hangman's Fracture is a bilateral neural arch fracture of C1.
3. C2 fractures comprise 6% of all cervical spine fractures
4. The Hangman's fracture is a hyperextension injury.
5. Anterior subluxation of C2 on C3, with avulsion of the anteroinferior corner of C2, plus prevertebral soft tissue swelling = the Hangman's fracture.

Back 4

2. C2

Front 5

Which is incorrect regarding Jefferson fractures?
1. They result from axial compression forces
2. Neurological deficits are quite common
3. They are unstable fractures.
4. Given that C1 is a ring shaped structure, at least 2 fracture sites inevitable exist.
5. The atlas articulates with the BASE OF SKULL superiorly, and C2 {axis} inferiorly.

Back 5

2. Relatively uncommon-due to increase in space for spinal cord within the spinal canal.

Front 6

Which is incorrect regarding cervical spine injuries?
1. The lateral cervical spine radiograph cannot be relied upon to "clear" the cervical spine
2. 15% patients with cervical spine fractures have normal lateral radiographs
3. 4% patients have normal 3-view radiographs.
4. The transverse atlantal ligament {TAL} holds the dens in position with the posterior arch of the atlas.
5. Widening of the PREDENTAL SPACE is a sign of TAL disruption.

Back 6

4. TAl holds dens in position with the anterior arch of C1

Front 7

Which is incorrect regarding Hangman's fractures [HF] ?
1. Hangman's fracture = "traumatic spondylolisthesis of the pars interarticularis of C2"
2. HF = bilateral PEDICLE fractures
3. The mechanism of the HF is hyperextension of the neck, with compression of the posterior elements of C2.
4. Hangman's fractures can be associated with no spinal cord injury.
5. Operative fixation is not a treatment option for Hangman's fractures.

Back 7

5. They often require operative fixation

Front 8

List the 4 main reasons / factors for potentially preventable neurological DETERIORATION in spinal cord injury?

Back 8

1. Unrecognised injury
2. Inadequate vertebral immobilisation
3. Secondary effects from oedema / ischaemia
4. Aggravation by hypoxia / hypotension

Front 9

which is incorrect regarding Spinal trauma?
1. 10% patients with one vertebral fracture have another vertebral fracture
2. "When thinking spine, think 'whole' spine"
3. Spinal cord injuries occur most commonly at the level fo C7T1 cervical vertebrae.
4. 2% of adult blunt trauma suffer a spinal injury.
5. 6% of adult blunt trauma victims with the presence of craniofacial injury suffer a spinal injury.

Back 9

3. C5-6 and C6-7
- account for almost 50% of all subluxation injuries.

Front 10

Which spinal cord syndrome is associated with the following findings below the level fo the lesion: total flaccid paralysis, total anaesthesia, total Analgesia, and areflexia.

Back 10

Transverse Spinal cord syndrome.

Front 11

What Spinal cord syndrome occurs due to a hyperextension injury, that compresses the cord via intervertebral discs and ligamentum flavum?

Back 11

Anterior central cervical cord syndrome

Front 12

What are the motor, sensory and reflex findings of anterior central cervical cord syndrome?

Back 12

Motor: weakness in UL and LL [ UL >>LL]
Sensory : sensory loss in UL and LL [ UL >> LL]
Reflexes: variable

Front 13

What spinal cord syndrome is usually a result of flexion-rotation, or vertical compression injury?

Back 13

ACute anterior cervical cord syndrome

Front 14

What are the motor and sensory findings in acute anterior cervical cord syndrome?

Back 14

Motor: Motor loss / paralysis below the injured segment
Sensory : Analgesia and loss of temperature / coarse
sensation below the injured segment.
Some preservation of joint position / vibration
sense and soft touch [dorsal columns]

Front 15

What are the features of Brown Sequard Syndrome - cord hemisection?

Back 15

Motor: Impaired IPSILATERAL motor function
Sensory: Impaired joint position / vibration sense and light
touch - IPSILATERAL
Impaired CONTRALATERAL spinothalamic
sensation- pain / temperature

Front 16

Which is incorrect regarding The autonomic effects of spinal cord damage?
1. There is significant impairment of total body sympathetic and pelvic parasympathetic functions after an injury higher than the cervical vertebrae.
2. Sympathetic denervation in complete quadriplegia, causes generalised systemic vasodilatation.
3. Priapism / penile engorgement occurs with complete quadriplegia
4. Unopposed parasympathetic supply to the heart via the vagus nerve leads to bradycardia.
5. Neurogenic shock = hypotension secondary to a drop in total peripheral resistance.

Back 16

1. Higher than the upper thoracic vertebrae.

Front 17

Which is incorrect regarding spinal cord injury?
1. Paralytic ileus develops , with recovery over 3-10 days
2. Passive aspiration of stomach contents occurs due to sphincter paralysis at the pylorus and lower oesophageal sphincter.
3. Urinary incontinence occurs due to bladder denervation and spinal shock.
4. Patients become "poikilothermic".
5. The capacity to vasoconstrict, to conserve heat, as well as shiver, to generate heat-is lost.

Back 17

3. Urinary retention

Front 18

which is incorrect regarding "Spinal shock"?
1. It is a different entity to "neurogenic shock"
2. it is likened , pathophysiologically, to "acute cord confusion"
3. It lasts for a few hours to several days
4. Both somatic and autonomic reflexes are lost below the injured segment.
5. Recovery from spinal shock is heralded by the return of the Babinski reflex, and then perineal reflexes.

Back 18

3. duration a few hours to several weeks

Front 19

An unstable cervical spine fracture is defined as - Which is incorrect?
1. The vertebral height anteriorly is less than 2/3 the height of the posterior vertebra.
2. The angle between 2 adjoining vertebrae is greater than 20 degrees.
3. There is more than 3mm of overriding of one vertebrae over another.
4. The anterior and posterior elements are disrupted
5. The height of the anterior vertebral body is less than 66% of the height of the posterior vertebral body.

Back 19

2. 11 degrees

Front 20

Which is incorrect regarding injuries to the thoracolumbar spine?
1. The principal mechanism of injury to the thoracic spine is hyperflexion
2. Most thoracic spine fractures are stable.
3. Most thoraco-lumbar spine fractures are flexion , or hyperflexion-rotation injuries, and are generally unstable.
4. fractures of the thoracolumbar spine comprise 25% of all vertebral fractures responsible for neurological deficits.
5. Thoraco-lumbar spine fractures can range from facet joint disruptions, to posterior bony fragments, or burst fragments.

Back 20

4. 40%

Front 21

Which is incorrect regarding lumbar spine fractures?
1. Seatbelt-lapbelt injuries from MVA are a significant source of lumbar spine fractures.
2. There are usually concurrent intra-abdominal visceral injuries with MVA lumbar spine fractures.
3. There are 3 main significant lumbar spine fracture types which are broadly considered as posterior distraction injuries of the vertebral arch.
4. Chance fractures of the lumbar spine extend form the spinous process, through the neural arch, into the vertebral body.
5. Horizontal fissure fractures and Smith fractures damage the intervertebral disc.

Back 21

5. Chance fractures damage the intervertebral disc.

Smith fractures spare the posterior spinous process, but involve disruption of the posterior ligaments.
Horizontal fissure fractures extend horizontally through the vertebral body.