Editing Spinal injuries (section)

== Specific injuries ==

* Atlanto-occipital dislocation
** Mostly die at scene due to apnoea
** Common cause of death in shaken baby syndrome
* Atlas (C1) fracture
** 40% are a/w C2 fracture
** Commonly burst fracture - axial loading
** Uncommon to be a/w spinal cord injury, but are certainly unstable, keep in collar
** Unilateral fractures are uncommon
* C1 rotary subluxation
** Most often seen in children
** Doesn't take much force sometimes
** Patient presents with torticollis
** Restrict motion with head in rotated position and refer
* C2 fractures
** 18% of all C-spine fractures
** Odontoid fractures
*** Normally positioned in contact with anterior arch of C1, held in place by transverse ligament
*** Type 1 fracture - odontoid tip
*** Type 2 - base
*** Type 3 - extend into body of C2
** Posterior element fracture (Hangman's)
*** Involves posterior elements of C2 - pars interarticularis
*** Usually caused by extension
*** Rigid collar and refer
* C3-C7
** C5-6 is most flexible, therefore most vulnerable to injury
** Incidence of neurologic injury is much higher with facet dislocations
* Thoracic
** Anterior wedge compression
*** Axial loading with flexion
*** Rarely more than 25%
*** Mostly kept stable by rigidity of ribcage
*** Mostly treated with a rigid brace
** Burst injuries
*** Vertical-axial compression
*** Probably needs fixation
** Chance fractures
*** Transverse fractures through vertebral body
*** Caused by flexion about an axis anterior to the vertebral column - MVA with poorly-placed seat belt
*** Can be a/w retroperitoneal and abdominal injuries - pancreas, duodenum
*** Probably needs fixation
** Fracture-dislocations
*** Relatively uncommon
*** Nearly always extreme flexion or severe blunt trauma to spine, which disrupts the posterior elements
*** Commonly results in complete neurological deficits
*** Probably needs fixation
* Thoracolumbar junction fractures (T11-L1)
** Combination of acute hyperflexion and rotation
*** Falls from height, restrained drivers at high speed
** Usually unstable
** Beware of spinal cord injury at L1 (bladder/bowels/lower limbs)
** Extremely vulnerable to rotational forces, be careful when logrolling
* Lumbar
** Similar to thoracic injuries
** Lower risk of spinal cord injury than thoracic
* Penetrating injuries
** Usually stable
* Blunt carotid/vertebral artery injuries
** Indications for screening (carotid angio and generally COW, but can be decided by radiology reg):
*** C1-C3 fractures
*** Cervical spine fracture with subluxation
*** Fractures involving foramen transversarium
*** Bruising to neck is soft, but can be indicated
*** Spinous process fractures probably doesn't need one
*** Base of skull fractures indicated
***