Done by Alaa Reem Noura Alia Shaden Spinal Injuries Done by Alaa Reem Noura Alia Shaden

Cervical Spine Injuries

Atlanto- Occipital Dislocation Hyperextension and distraction mechanism Down’s syndrome, RA more susceptible Asymmetric lateral masses on odontoid view Widened predens space Treatment- Often fatal Highly unstable If not fatal avoid traction

Atlas Fractures Neural Arch Fracture of C1 Most common fracture of C1 Hyperextension injury Not associated with neurologic deficit May be confused with congenital abnormality

Jefferson fracture Burst fracture of atlas (C1) Usually bilateral breaks in ant/ post arches Vertical compression/ axial load injury Widened lateral masses of C1 on open-mouth odontoid view Widened predens space Neuro deficits uncommon

Axis Fractures Odontoid fracture Incidence: 6% of cervical spine fractures Associated with atlas fractures in 8% Hyperextension Often forward subluxation of C1 on C2 Odontoid fracture Type I Type II Type III

Hangman’s Fracture Most common fracture of C2 Bilateral fracture of pedicles of axis (C2) Anterior slip of C2 on C3 Mechanism: Sudden deceleration with hyperextension May or may not have anterior subluxation Unstable

Compression Fracture Flexion injury Anterior wedging of 3mm or more suggests fracture Usually involves superior endplate of vertebral body

Unilateral facet dislocation Mechanism: flexion, combined flexion/ rotation Anterior dislocation of one vertebral body by 25- 30% on lateral view Only 30% associated with neurologic defect

Bilateral Facet Dislocation Mechanism: flexion, combined flexion/ rotation Anterior dislocation of one vertebral body by 50% on lateral view Unstable Neurologic deficits common Seen in up to 85%

Lumbar spine fracture

Lumbar spine fracture The lumbar vertebrae are the 5 largest and strongest of all vertebrae in the spine & it comprises the lower back. Causes Traumatic fractures  Non-traumatic fractures

Traumatic fractures caused by high-energy trauma, such as: Car crash Fall from height Sports accident Gunshot wound

Non-traumatic fractures caused by a disease, such as: Osteoporosis Multiple myeloma (bone Tumour) Bone Metastasis

Fractures types 1-Flexion Wedge Compression fracture A burst fracture 2- Extension Chance fracture. 3- Rotation Transverse process fracture 4- Fracture-dislocation Spondylolisthesis

Wedge Compression fracture The vertebral body is compressed. the front of the vertebra is breaks. the back part does not effected. Most Common fracture & usually it is stable & painful # Cause by: an external force is applied to the spine, such as a fall or carrying of a sudden heavy weight Rarely associated with neurologic problems.

Burst fracture Is axial compression fracture in which the entire spinal vertebra breaks. The vertebra is break on both the front and back sides. Caused by a fall from a height and landing on the feet.

Chance fracture It is acute hyperflexion of the spine which distraction the  posterior and impaction of the anterior vertebra. L1 and L2 most commonly Common symptom is a back pain

Transverse process fracture Multiple avulsion fractures. Results from severe hyperextension and lateral flexion The most common fractures are L2 and L3

Spondylolisthesis The vertebra (usually L5) is slips forward or backward compared to the next vertebra(usually the sacrum). it is more common in girls than boys.

Symptoms: Low back pain Feeling of “hamstring tightness” Pain radiating down the legs Difficulty with upright posture and gait

Sacral Fracture

Sacral Fracture What is a sacral fracture? A sacral fracture is a break in your sacrum. Which is a triangle-shaped (three sided) bone made up of five fused (joined) vertebrae. A sacral fracture more commonly occurs in older adults because they have weaker bones, Young, active people, may also get sacral fractures.

What causes a sacral fracture? Sacral fractures are usually caused by an injury to the sacrum. These injuries can be caused by any of the following: 1-Activities which are too hard for the sacrum to withstand. 2-Car accidents. 3-Fall from height. 4-Having diseases that affect the bone, such as osteoporosis, or bone cancer.

Types of sacral fractures : Sacral Stress Fractures Sacral Insufficiency Fractures Traumatic Sacral Fractures

Sacral Stress Fractures : a sacral stress fracture occurs in young, active patients. These injuries are closely related to sacral insufficiency fractures described below, but the bone is usually not osteoporotic. Rather than the bone not being healthy enough, the activities simply are too much for the sacrum to resist, and a stress fracture results.

Sacral Insufficiency Fractures Sacral insufficiency fractures usually are parallel to the spine. They are most often in the ala, just beside the sacroiliac joint, and sometimes there is also a transverse fracture. It is occur in elderly patients with osteoporosis. These fractures may be the result of a fall or may be the result of no particular injury.

Sacral Insufficiency Fractures : Sacral insufficiency fractures may not be seen on regular x-rays, but usually show up on MRI or CT scans of the pelvis.

Traumatic Sacral Fractures : Traumatic fractures of the sacrum can occur with pelvic fractures. These injuries commonly occur in car accidents and severe falls.

Coccyx (Tailbone) Coccyx fracture Coccyx Dislocation

Coccyx fracture The coccyx is the final vertebral segments of the spinal column and is commonly called the tailbone. Tailbone fracture is a fracture to the small bone at the lower tip of the spine. Actual fractures of the tailbone (coccyx) are not common. Causes : A fall onto the tailbone in the seated position, usually against a hard surface, is the most common cause of coccyx injuries. The coccyx can be injured or fractured during childbirth.

Coccyx dislocation The dislocation of the coccyx occurs when there is a separation of the coccyx from the sacrum. The coccyx may displacement Backwards or forward.

Causes : In order for the coccyx to be displaced, it must be subjected to a significant force. The two most frequent causes are: 1-Falling on the tailbone, where the intensity of the fall displaces the coccyx. 2-Labor, in which the fetus displaces the coccyx, usually backwards, during its passage through the birth canal. This can occur when the size of the baby and the size of the mother's pelvis are slightly out of proportion

References http://www.eorthopod.com/content/adult-thoracic-spine-fractures-types http://www.eorthopod.com/content/adult-lumbar-spine-fractures-types http://orthoinfo.aaos.org/topic.cfm?topic=a00368 http://www.radiologyassistant.nl/en/4906c8352d8d2 http://www.imageinterpretation.co.uk/thoracolumbar.html http://www.drugs.com/cg/sacral-fracture.html http://orthopedics.about.com/od/brokenbones/g/sacral.htm http://radiographics.rsna.org/content/21/1/83.full http://www.emedicinehealth.com/tailbone_coccyx_injury/page2_em.htm http://www.cure-back-pain.org/coccyx-injury.html http://www.espalda.org/english/divulgativa/dolor/causas/alteraciones/coxis.asp

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