Neurosurgery notes/Fracture map

Fracture map

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Parent item
Spinal Trauma
Sub-item
Thoracolumbar fractures
Cervical spinal fractures

Summary

Fracture type
Numbers
Classification
C0 fractures
0.4% of trauma patients
  • Anderson & Montesano
      1. Compression fracture
      1. Linear skull base fracture
      1. Avulsion fracture
  • Maserati classification
    • C0/C1 joint interval < 2mm
C0/C1 dislocation
1% of patients with “cervical spine injuries
  • Traynelis classification (direction of displacement)
      1. Anterior dislocation of occiput in relation to atlas
      1. Superior dislocation of occiput in relation to atlas
      1. Posterior dislocation of occiput in relation to atlas
  • Harbourview classification (degree of instability)
      1. Minimal or non-displaced, unilateral injury to craniocervical ligaments
      1. Minimally displaced, but MRI demonstrates significant soft-tissue injuries.
      1. Gross craniocervical misalignment
C1/C2 dislocation
 
  • Rotatory subluxation Fielding & Hawkins
      • Type
      TALᵃ
      Facet injury
      AD (mm)
      Comment
      I
      Intact
      Bilateral
      ≤ 3
      Dens acts as pivot
      II
      Injured
      Unilateral
      3.1–5
      Intact joint acts as pivot
      III
      Injured
      Bilateral
      > 5
      Rare. Very unstable
      IV
      Incompetent of the odontoid with posterior displacement
      Incompetent of the odontoid with posterior displacement
      ㅤ
      Rare. Very unstable
    • ᵃTAL = transverse atlantal ligament, AD = anterior displacement of C1 on C2
  • Anterior subluxation
      1. Disruption of TAL
        1. Dickman type 1 (Ligamentous disruption)
        2. Dickman type 2 (Avulsion)
      1. Incompetence of odontoid process
C1 fracture
3–13% of cervical spine fractures
  • Landells classification
      1. Isolated anterior or posterior arch fracture
      1. Jefferson burst fracture with bilateral fractures of anterior and posterior arch
      1. Unilateral lateral mass #
C2 Peg fracture
10-15% of all cervical fractures
  • Anderson and D'Alonzo classification
      1. Tip
      1. Waist of Peg- Grauer subclassification classification
          2. a) Non displaced
          b) Superiorly angulated fracture
          c) Inferiorly angulated fracture
      1. Body of Peg
C2 traumatic
 
  • Levine/Effendi classification
      1. Vertical fracture of pars
        1. Involving of transverse foramina
      1. Vertical fracture of pars + C2/3 disc disruption
        1. Oblique fracture of pars
      1. Vertical fracture of pars + C2/3 disc disruption + Facet joint capsule disruption
TL fractures
 
Category
Criteria
Points
Method
Morphology (immediate stability)
Compression
Burst
Translation/rotation
Distraction
1
2
3

4
• Radiographs
• CT
Integrity of PLC (longterm stability)
Intact
Suspected
Injured
0
2
3
MRI
Neurological status
Intact
Nerve root
Complete cord
Incomplete cord
Cauda equina
0
2
2
3

3
Physical examination
Predicts
Need for surgery
0 – 3
4

> 4
• Nonsurgical
• Surgeon's choice
• Surgical

Fracture mechanism

Upper cervical spine
Distraction
Atlanto-occipital
Unstable
Occipito-cervical fusion
Rotation
Atlanto-axial subluxation (rotatory fixation)
Potentially Unstable
Closed reduction and Halo immobilization for 8-10 weeks
Axial compression
Jefferson’s fracture
Unstable
Halo immobilization
Hyperextension and axial compression
Hangman’s fracture
Unstable
Halo immobilization
Flexion (or less commonly extension)
Odontoid peg fracture
Type II and III unstable
Halo immobilization (surgery in Type II if > 50-years old)
Subaxial cervical spine
Axial compression
Burst fracture
Unstable
Anterior and posterior instrumented fusion
Hyperflexion
Clay shoveler’s (spinous process avulsion)
Stable
Cervical collar
Flexion and axial compression
Compression (wedge)
Stable
Cervical collar
Flexion and axial compression (severe)
Flexion teardrop
Unstable
Open reduction and instrumented fusion
Flexion-distraction
Facet dislocation; posterior ligamentous injury
Unstable
Open reduction and instrumented fusion
Extension
Extension teardrop (avulsion)
Stable
Conservative or orthosis
Spinous process/lamina fracture
Stable
Cervical collar
Extension and axial loading
Lateral mass/facet fracture
Stable or unstable
Stable—cervical collar 6 weeksUnstable—closed or open reduction and anterior/posterior/combined stabilization
Thoracolumbar spine
Axial compression
Burst
Unstable
TLSO or Surgical stabilization
Flexion and axial compression
Compression (wedge)
Stable
Conservative or TLSO
Flexion and axial compression (severe)
Flexion teardrop
Unstable
Open reduction and surgical stabilization
Extension
Extension teardrop (avulsion)
Stable
Conservative or TLSO
Flexion
Chance fracture
Unstable
Surgical stabilization
Flexion-distraction
Facet dislocation; PLC injury
Unstable
Open reduction and surgical stabilization
Shear/rotation
Translocation (fracture dislocation)
Unstable
Open reduction and surgical stabilization

Images

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