Common cervical fractures Presented by: Dr fahad albader

Question (1) e c f a h d i b g j k

Question (2) e g a b c f d

Question (3) What is the name of this view? What is your findings? What is your Dx.? What is your next step?

Question (4) What is your findings? What is your Dx.? Is it stable or unstable?

Question (5) What is your findings? Which ligament is affected? What is your Dx.? Is it stable or unstable?

Question (6) What is your findings? Which ligaments are affected? What is your Dx.? Is it stable or unstable?

Question (7) What is your findings? What is your Dx.? What are the most common sites? Is it stable or unstable?

Question (8) What is your findings? What is your Dx.? Which type has the worst prognosis?

Question (9) What is your findings? What is your Dx.? Is it stable or unstable?

The answers

Question (1) e c f a h d i b g j k

Answer (1) Intervertebral disc. Spinous process. Transverse process. Pedicle. Dense of C2. Body of C7. Facet joint. Lamina. Spinous process of C7.

Question (2) e g a b c f d

Answer (2) Dense of C2. Lateral mass of C1. Body of C2. Anterior vertebral line. Posterior vertebral line. Spinolaminar line. Posterior spinous line.

Question (3) What is the name of this view? What is your findings? What is your Dx.? What is your next step?

Jefferson Fracture Compression fracture of the bony ring of C1. The key radiographic view is the AP open mouth. Displacement of the lateral masses of C1 beyond the margins of the body of C2 (>2mm). CT is required. It is unstable fracture.

Normal vs abnormal

Jefferson Fracture

Question (4) What is your findings? What is your Dx.? Is it stable or unstable?

Hangman's Fracture Radiographic features: (best seen on lateral view) 1. Prevertebral soft tissue swelling. 2. Avulsion of anterior inferior corner of C2 associated with rupture of the anterior longitudinal ligament. 3. Anterior dislocation of the C2 vertebral body. 4. Bilateral C2 pars interarticularis fractures. Unstable fracture.

Question (5) What is your findings? Which ligament is affected? What is your Dx.? Is it stable or unstable?

Flexion Teardrop Fracture Radiographic features: (best seen on lateral view) 1. Prevertebral swelling associated with anterior longitudinal ligament tear. 2. Teardrop fragment from anterior vertebral body avulsion fracture. 3. Posterior vertebral body subluxation into the spinal canal. 4. Spinal cord compression from vertebral body displacement. 5. Fracture of the spinous process. Unstable fracture.

Question (6) What is your findings? Which ligaments are affected? What is your Dx.? Is it stable or unstable?

Bilateral Facet Dislocation Radiographic features: (best seen on lateral view) 1. Complete anterior dislocation of affected vertebral body by half or more of the vertebral body AP diameter. 2. Disruption of the posterior ligament complex and the anterior longitudinal ligament. 3. " Bow tie" or " bat wing" appearance of the locked facets. Unstable fracture.

Unilateral Facet Dislocation Radiographic features: (best seen on lateral or oblique views) 1. Anterior dislocation of affected vertebral body by less than half of the vertebral body AP diameter. 2. Discordant rotation above and below involved level. 3. Facet within intervertebral foramen on oblique view. 4. Widening of the disk space. 5. "Bow tie" or "bat wing" appearance of the overriding locked facets. Stable fracture.

Bow tie appearance

Question (7) What is your findings? What is your Dx.? What are the most common sites? Is it stable or unstable?

Clay Shoveler's Fracture Fracture of a spinous process C6-T1. Radiographic features: (best seen on lateral view) 1. Spinous process fracture on lateral view. 2. Ghost sign on AP view (i.e. double spinous process of C6 or C7 resulting from displaced fractured spinous process). Stable fracture.

Question (8) What is your findings? What is your Dx.? Which type has the worst prognosis?

Odontoid Fractures Best seen on lateral view. Sometimes the only sign of fracture may be just prevertebral soft tissue swelling. fracture line may be better delineated by CT.

Dens Fracture Type I fracture in superior tip of the odontoid. It is unstable fracture. Rare fracture.

Dens Fracture Type II fracture at base of odontoid. the most common type. Unstable fracture.

Dens Fracture Type II

Dens Fracture Type III Fracture through base of odontoid into body of axis. It has the best prognosis.

Question (9) What is your findings? What is your Dx.? Is it stable or unstable?

Burst Fracture fracture of C3-C7. Injury to spinal cord, secondary to displacement of posterior fragments . Common. Unstable.

Wedge Fracture Radiographic features: 1. Buckled anterior cortex. 2. Loss of height of anterior vertebral body. 3. Anterosuperior fracture of vertebral body. Stable

Mechanism of Injury

Summery Type of Injury Fracture Flexion Extension Compression Complex Unilateral facet dislocation Bilateral facet dislocation Wedge compression fracture Flexion teardrop fracture Clay Shoveler's fracture Extension Hangman's fracture Compression Jefferson fracture Burst fracture Complex Odontoid

Summary Stable unstable Unilateral interfacetal dislocation Simple wedge fracture Burst fracture. Clay Shoveler's fracture unstable Bilateral interfacetal dislocation Flexion teardrop fracture Hangman's fracture Jefferson fracture of atlas

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