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Ortho PANRE 1
Orthopedics
| Question | Answer |
|---|---|
| What ligaments hold atlas to axis & keep it stable? | Alar ligaments |
| If one of the two vert columns is intact, then: | the injury is stable |
| If both columns are disrupted, then: | the injury is unstable |
| Radiology: Trauma: | order lateral, AP, & odontoid view; all 7 vertebrae must be seen |
| Tx Jefferson fx: unstable | Cranial traction; halo x 3 months; > 5mm C1-C2 subluxation = C1-C3 fusion |
| Odontoid fx types | type I (rare): avulsion fx of alar ligament; type II & III |
| Burst Jefferson fx stability: determined by: | transverse ligament |
| Burst Jefferson fx stability: neuro effects | Usually neuro intact (fragments burst away; wide breadth of C1 canal) |
| Burst Jefferson fx: 1/3 of fx assoc with: | an axis fx |
| Burst Jefferson fx: 50% chance that: | some other C spine injury is present |
| Odontoid fx MOA | Hyper-flexion or hyper-extension |
| Hangmans Fx = | Traumatic Spondylolisthesis of C2 (bilateral C2 pedicle fx) |
| Hangmans Fx MOA | hyperextension & sudden violent distraction; hyperextension & axial loading; or flexion & compression (usu combination of forces) |
| Hangmans Fx: Types | 4 types (I, II, IIA, III = worst) |
| Hangmans Fx: Immobilization: | rigid cervical orthosis or halo vest system |
| Hangmans Fx: Traction: | used generally for reductions (Gardner-Wells tongs or halo vest system) |
| Acute Cervical Sprain = | Injury to restraining ligaments of cervical spine |
| Acute C- Sprain grade I (mild): | ligaments damaged but not lengthened |
| Acute C- Sprain grade II (mod): | some laxity but not total disrupt |
| Acute C- Sprain grade III (severe): | ligament completely disrupt |
| Acute C- Sprain: if instability present, may need: | 6-12 wks immobilization in rigid orthosis and/or surgery |
| Cervical Stenosis = | narrowing of sagittal diameter of cervical canal |
| C-stenosis: segments most commonly involved | C5 and C6 segments |
| Cervical Stenosis Types | Congenital; Developmental; Acquired |
| C-stenosis: Congenital = | short pedicles, funnel shape of cervical canal |
| C-stenosis: Developmental = | bone size due to stress in weight training |
| C-stenosis: Acquired = | spondylosis, spurs, disc bulge or space narrowing |
| Cervical Spondylosis = | Chronic disc degeneration (arthritis) |
| Cervical Spondylosis: Represents: | nerve root compression |
| Cervical Spondylosis S/S: | neck pain, radicular pain radiating from neck to upper extremity |
| Cervical Spondylosis Rx: | supportive, facet injections, operative decompression |
| Brachial Plexus = | C5, C6, C7, C8, T1 |
| Odontoid fx: tx | Reduce fx & hold in halo immobilization (3 months); C1-C2 fusion if severely displaced or non-union; Few advocate acute ORIF dens |
| Hangmans Fx: Stability: | unstable; neuro deficit is surprisingly rare unless C2 - C3 subluxation is severe |
| Hangmans Fx: Tx | will usually stabilize with halo fixation; anterior fusion may be needed due to delayed instability |
| Hangmans Fx: Operative Tx: | occipitocervical fusion; atl-axial fusion; transarticular screw fixation; ant. screw fixation of dens; internal fixation w/ posterior plating of occiput to C2 |
| Evaluation of cervical instability (White & Punjabi ) | Vert malalignment; >3.5mm translational displacement; 1.7 mm or greater disk widening |
| C Spine injuries: Tx | Philadelphia collar immobilization (stable); Halo immobilization (stable); Occipito-cervical fusion (unstable) |
| Most common Spinous Process fx found in: | C-spine (Clay Shovelers fx) |
| Axial blow to the head with force transmitted through the occipital condyles; Forces the lateral masses of C1 outward | Jefferson fracture |
| bilateral C2 pedicle fractures (usually due to combo of forces; eg, hyperextension and sudden violent distraction) | Hangman's fracture |
| Back Pain: lifetime prevalence: | 60-80% |
| Disc degeneration MOA: | degeneration overloads facet joints in verts |
| Disc herniation MOA: | herniation impinges nerve roots |
| Pain: Red Flags | > 50 y.o.; kids; Night Pain; Fever, malaise, wt loss; Bladder/ bowel dysfunction; Progressive deficit; Prior ca; Pain > 1 month |
| Bragards test: | Foot dorsiflexion increases back pain |
| FABER test: | Pain in SI joint |
| 70% of LBP is due to: | Lumbar Strain |
| HNP: most common sites | L4-5, L5-S1 |
| HNP: MOI: | Flexion & rotation; Tears in annulus |
| Cauda Equina Syn: affects: | L2-L4 nerve roots |
| Cauda Equina Syn: Mechanism: | Compression of nerve roots causes paralysis without spasticity (LMN) |
| Cauda Equina Syn: Etiology: | Central disc herniation, abscess, hematoma |
| Cauda Equina Syn: Sx: | Loss of bladder/ bowel control, bilateral LE weakness & sensory deficits |
| Cauda Equina Syn: Rx: | Emergent Surgical Decompression |
| Spondylolysis = | Pars interarticularis stress fx |
| Spondylolysis: occur most often at: | L5 |
| Spondylolysis: x-ray | Scotty dog collar only on oblique xray |
| Spondylolisthesis = | Vertebral sliding (dancers, gymnasts) |
| Spondylolisthesis: PE: | Step-off, may be asymptomatic |
| Spondylolisthesis: Grading | Grade I – V (25 to >100%); Isthmic, degenerative |
| Spondylolisthesis: x-ray | Lateral film shows slip |
| Piriformis Syndrome = | Irritation of sciatic n. (L4,5, S1,2,3) beneath piriformis mx |
| Scoliosis: Xray Cobb angle: | Measure angle from tilted vertebrae above & below apex of curve |
| 50% of pts with solid tumors have: | mets to spine |
| Tumor: Highest prevalence: | BrCa, lung, prostate, colon, thyroid, kidney ca (hematogenous spread) |
| Tumor: Sx: | Night pain, n. root compression |
| 10% of spinal bone tumors are: | primary |
| Spinal bone tumors: in children, 20% are: | malignant |
| Spinal bone tumors: Primary malignant: | Osteosarcoma, Ewing Sarcoma, Chondrosarcoma |
| Facet Syndrome = | n. root compression by loss of disc height & facet hypertrophy |
| Ankylosing Spondylitis: Sx: | Chronic low back pain in young adults; morning stiffness, improves with movement; 20% peripheral joint sx (Enthesopathies common; 25% with anterior uveitis) |
| Ankylosing Spondylitis: PE: | Schobers test (normal is 5 - 7 cm movement) |
| Ankylosing Spondylitis: X-ray: | Erosion & sclerosis on plain films |
| Ankylosing Spondylitis: Rx: | PT, NSAIDs, Sulfasalazine, Infliximab |
| Schobers Test: Less than 5 cm difference suggests: | pathology |
| Ankylosing Spondylitis = | Calcification btw vertebral bodies at edge of discs; gives appearance of bamboo stalk; sclerosis of SI joint |
| Spine Films/ Frontal: Vert body: Crack in owls eye: in = | Chance fx (seat belt fx) |
| LBP: most common site of disk herniation | L5-S1 (also L4-L5) |
Created by:
Abarnard
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