1. Naftaly Attias, MD Orthopedic Department St Josephs HMC –Phoenix, AZ
Basic Spine Fractures
Naftaly Attias, MD
Orthopedic Department
St Josephs HMC –Phoenix, AZ

2. Atlas Fracture
Levine and Edwards classification
Jefferson fracture

3. Atlas Fracture 43% of C-1 Fx associated with a C-2 fracture
Complete transverse ligament insufficiency has to be assumed if the combined overhang of the C-1 lateral masses relative to the lateral mass walls of C-2 amounts to 7 mm or more
Halo traction is effective in reducing the spreading of the lateral masses
This reduction is not maintained in a halo vest

4. Dense Fracture Anderson & D'Alonzo Classification
Type I - avulsion fracture of the tip of the odontoid. It may imply a more extensive craniocervical ligamentous disruption
Type II - located at the waist of the odontoid
Type III - extend into the body of the axis

5. Dense Fracture Risks factor for Non-Union
Type II injury with > 5 mm displacement initially
Can't be reduce in traction < 2-3 mm
Can't be maintained in a halo
Elderly patient??

6. Dense Fracture

7. Traumatic Spondylolisthesis of the Axis [hangman's fracture]
Effendi Classification (modified by Levine)
A: Type I, nondisplaced fracture of the pars interarticularis ⇒ collar
B: Type II, displaced fracture of the pars ⇒ Traction - Halo
C: Type IIa, displaced fracture of the pars with disruption of the C2–3 discoligamentous complex ⇒NO Distraction - Halo
D: Type III, dislocation of C2–3 facets joints with fractured pars ⇒ NO Traction - ORIF

8. Traumatic Spondylolisthesis of the Axis [hangman's fracture]
Type IIA

9. Traumatic Spondylolisthesis of the Axis [hangman's fracture]

10. Cervical Fractures Burst
Pure axial loading injuries
Cause neurologic injury
Usually need operative treatment if unstable or cause neuro deficit

11. Cervical Fractures Burst

12. Cervical Fractures – Unilateral Facet dislocation
Caused by flexion & axial rotation - coupled motion ⇒ requires both to dislocate
The facet is intact
Once reduced (if can be reduced) - stable injury
Unilateral facet fracture - also a flexion rotation injury. But even if reduced ⇒ still residual rotational instability = different treatment

13. Cervical Fractures – Bilateral Facet dislocation
High rate of neuro deficit
Close reduction in traction
MRI : 1. if during an awake reduction demonstrates paresthesias 2. any deterioration of neuro status 3. difficulty or failure in achieving an awake closed reduction necessitating a reduction under anesthesia

14. Cervical Fractures – Bilateral Facet dislocation

15. Thoraco-Lumbar Fractures
Denis – 3 column

16. Thoraco-Lumbar Fractures
Denis - Compression

17. Thoraco-Lumbar Fractures
Denis - Burst
Axial Load
Axial load + flexion
Axial load + flexion
Axial load + Lateral bending
Axial load + Rotation

18. Thoraco-Lumbar Fractures
Denis – Flexion-Distraction (seat belt)
Chance

19. Thoraco-Lumbar Fractures
Denis – Fracture - Dislocation
Flexion Rotation
Shear
Flexion Distraction

20. Thoraco-Lumbar Fractures
The goals of treatment operative or otherwise:
Protect neural elements, restore/maintain neurological function
Prevent or correct segmental collapse and deformity
Prevent spinal instability and pain
Permit early ambulation and return to function
Restore normal spinal mechanics

21. Thoraco-Lumbar Fractures
Unstable injuries include all those with any of the following:
Three-column disruption (Two ???)
Greater than 50% collapse of anterior cortex
Greater than 20-25° of focal kyphosis
Any extent of neurologic deficit
Patients with extensive associated injuries
Greater than 50% canal compromise at L-1 and 80% compromise at L-5.

22. Thoraco-Lumbar Fractures

23. Thoraco-Lumbar Fractures

24. Thank You

25. Helpfulness of Material
SWOTA : 2010 Resident Course - Fundamentals of Fracture Care
Basic Spine Fractures
Helpfulness of Material
A) B) C) D) E)
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COMMENTS Please

26. Quality of Presentation
SWOTA : 2010 Resident Course - Fundamentals of Fracture Care
Basic Spine Fractures
Quality of Presentation
A) B) C) D) E)
Worst Bad OK Good Best
COMMENTS Please