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34 Cards in this Set

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  • Back
(Thorax -> Lumbar) transitional anatomy?
1. Loss of stabilizing costal ligaments
Denis Three Column Model?
1. Ant Column -- ALL to half vertebral body
2. Middle Column -- half vertebral body through PLL
3. Post Column -- anything post to PLL
Where do compression fractures occur?
In the anterior column.
Location of burst fractures?
Due to failure of both the anterior and middle columns.
Which column determines stability?
Middle column, especially with respect to the PLL integrity.
Chance fracture?
Often due to MVA without shoulder belt:

1. Compression: anterior column
2. Distraction: middle + posterior columns
Orientation of thoracic facet joints?
Frontal/Coronally orientated facet joints.
Orientation of lumbar facet joints?
Sagittally orientated facet joints.
Do curves of the spine help absorb/dissipate axial loads?
Yes.

Therefore, the straight thoracolumbar junction is uniquely susceptible to axial load fractures.
Radiograph of compression fracture?
1. Wedge shaped vertebra
2. Posterior vertebral angle <100°
(3. PVA >100° a/w unsable burst fracture)
Denis Compression Fractures?
Type A: failure of sup+inf end plates
Type B: failure of sup end plate
Type C: failure of inf end plate
Type D: failure of vertebral body
Most common Denis compression fracture?
Type B.
How to calculate the percentage of vertebral height loss?
1 - (ant vertebral height/post vertebral height)
Cobb's Angle?
Where is back pain usually in kyphosis?
At apical segment or caudad.
Kummell's Disease?
Delayed post-traumatic osteonecrosis, may be AVN.
Mechanism of burst fractures?
Supraphysiological axial load drives surrounding tissue into the vertebral body, fracturing bone in process.
Denis classification of burst fractures?
Type A: failure of sup+inf end plates.
Type B: failure of sup end plate.
Type C: failure of inf end plate.
Type D: axial load + rotation
Type E: axial load + lat flextion
Most common Denis burst fracture?
Type B.
What portion of vertebral body compresses spine in burst fractures?
Typically bone from sup end plate.
Complications of chance fractures?
1. High rate if intra-abdominal injuries (45%).

2. 15% rate of neurologic involvement.
Special consideration in tx of chance fracture?
Obtain CT of middle column.

Reduction of Chance fracture requires compression of middle/posterior columns. This could be hazardous in the setting of comminuted fractures of the middle column.
What columns are involved in a fracture dislocation?
All three Denis columns.
Which column has the highest rate of neurological injury?
Fracture-dislocation.
Frankle Classification of neurological injury?
Class A: No motor or sensory
Class B: No motor, some sensory
Class C: unuseful motor, some sensory
Class D: useful motor, some sensory
Class E: normal motor, normal sensory
ASIA Impairment Scale?
Class A: No motor or sensory
Class B: No motor, some sensory
Class C: motor in less than half the muscle groups, some sensory
Class D: motor in more than half the muscle groups, some sensory
Class E: normal motor, normal sensory
CT measurements of spinal column for potential neuro compromise?
Ratio of midsagital:transverse diameters.

Elevated ratios correlated with increased risk of neuro involvement.
What kind of injury if air in posterior subcutaneous tissue or within spinal elements?
Possibly flexion-distraction.
How to treat stable compression fractures?
Orthosis brace for 12 weeks.
How to treat pure Chance fracture?
If only damage to the boney parts:

1. Hyperextended position
2. Orthosis
How to treat Chance fracture with soft tissue involvement?
Will not heal predictably, therefore surgery is required.
When to do spinal surgery?
There is no substantial difference in outcome between early and late surgical decompression and stabilization.
Holdsworth's model of the spinal column?
A two column model.

Anterior Column: PLL and anterior
Posterior Column: Posterior to PLL
Benefit of Holdsworth's model?
The majority of stability providing resistance to progression to kyphosis comes from the posterior column -- aka the middle is redundant.