Avulsion Fracture of Anterior Arch of Atlas
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Questions and Answers

What can result from retropulsion of vertebral body fragments?

Neurologic symptoms associated with narrowing of the spinal canal

What imaging modality is useful for defining bony anatomy in cases of spinal cord compression?

CT

What is the term for degenerative changes of the discs, vertebral bodies, and facet joints that develop with aging?

Spondylosis

What is the term for bony outgrowths that form as a result of inflammation and ossification of the outer fibers of the annulus fibrosis?

<p>Osteophytes</p> Signup and view all the answers

What is the term for inflammation and ossification of the Sharpey's fibers, classically seen in ankylosing spondylitis?

<p>Syndesmophytes</p> Signup and view all the answers

What is the term for the formation of cysts in the subchondral bone, characteristic of spondylosis?

<p>Subchondral cyst formation</p> Signup and view all the answers

What is the characteristic feature of vertebral body squaring in ankylosing spondylitis?

<p>Loss of normal concavity of the anterior border</p> Signup and view all the answers

What is the term for horizontal splitting of the spine and neural arch, associated with frontal impact seatbelt injury?

<p>Chance fracture</p> Signup and view all the answers

What is a characteristic radiographic feature of sacroiliac joints in ankylosing spondylitis?

<p>Sclerotic changes and ill-defined joint margin</p> Signup and view all the answers

What is the term for bony outgrowths that occur at the site of ligament and tendon insertion?

<p>Osteophytes</p> Signup and view all the answers

What is the characteristic feature of normal SI joints on radiography?

<p>Consistent joint space with no osteophytes, joint margin sclerosis, bony erosions, or ankylosis</p> Signup and view all the answers

What is the term for a fracture that occurs in the transverse process of a vertebra?

<p>Fracture of transverse process</p> Signup and view all the answers

What type of fracture occurs when the hyperextension force in the upper cervical spine is transmitted through an intact anterior longitudinal ligament and other anterior muscular attachments?

<p>Avulsion fracture of the anterior arch of atlas</p> Signup and view all the answers

Which projection is best for demonstrating an avulsion fracture of the anterior arch of atlas?

<p>Lateral projection</p> Signup and view all the answers

What is the usual mechanism of injury for a fracture of the posterior arch of the atlas (C1)?

<p>Severe hyperextension causing compression between the occiput and the heavy posterior arch of the axis</p> Signup and view all the answers

What is the characteristic feature of a hyperextension teardrop fracture of the Axis?

<p>A small triangular fragment of bone avulsed from the anterior, inferior border of C2</p> Signup and view all the answers

What is the site of insertion of the intact anterior longitudinal ligament in a hyperextension teardrop fracture of the Axis?

<p>The anterior, inferior border of C2</p> Signup and view all the answers

What is the characteristic radiographic feature of a Hangman's Fracture?

<p>Prevertebral soft tissue swelling and anterior subluxation of the C2 vertebral body</p> Signup and view all the answers

What is the difference between a fracture of the posterior arch of the atlas and a Jefferson fracture?

<p>The mechanism and anterior arch fracture are different</p> Signup and view all the answers

What is the stability of a fracture of the posterior arch of the atlas (C1)?

<p>Stable</p> Signup and view all the answers

What is the common site of 'bow tie' or 'bat wing' appearance of the overriding locked facets?

<p>C5-C6</p> Signup and view all the answers

What is the characteristic of the cord compression in a hyperextension strain or sprain in a spondylitic patient?

<p>Compressed between the enfolded and hypertrophied ligamentum flavum (posterior cord) and osteophytes (anterior cord)</p> Signup and view all the answers

What is the radiological finding in the disc at C5/6 in a hyperextension injury?

<p>Widening anteriorly and narrowing posteriorly</p> Signup and view all the answers

What is the age group in which a hyperextension strain or sprain can result from low impact forces?

<p>90 years old and above</p> Signup and view all the answers

What is the anatomical structure that is compressed in a hyperextension strain or sprain in a spondylitic patient?

<p>Cord</p> Signup and view all the answers

What is the radiological finding that may only be seen on plain films in a hyperextension strain or sprain in a spondylitic patient?

<p>Changes of spondylosis or degenerative arthritis</p> Signup and view all the answers

What is the primary assessment feature when reviewing the cervical spine radiograph?

<p>Vertebral alignment (spinous processes alignment)</p> Signup and view all the answers

Which column of the spine involves the anterior two-thirds of the vertebral body/intervertebral disc, and the anterior longitudinal ligament?

<p>Anterior column</p> Signup and view all the answers

What is the significance of the middle column disruption in spinal injuries?

<p>If the middle column is disrupted, either the anterior or posterior columns are also involved, and the injury is unstable</p> Signup and view all the answers

What is the purpose of evaluating prevertebral soft tissues when assessing the cervical spine radiograph?

<p>To identify potential abnormalities or injuries</p> Signup and view all the answers

What are the essential criteria for evaluating the technical quality of diagnostic medical images?

<p>Anatomical details and technical quality</p> Signup and view all the answers

What is the significance of recognizing diagnostic limitations of different imaging modalities?

<p>To inform accurate diagnosis and treatment</p> Signup and view all the answers

What is the purpose of developing a search pattern for specific structures when interpreting diagnostic medical images?

<p>To accurately identify and interpret abnormalities and pathologies</p> Signup and view all the answers

What is the role of critical thinking and problem-solving skills in radiodiagnosis?

<p>To provide informed opinion on radiodiagnosis using rational and technical acumen and rigorous argument</p> Signup and view all the answers

Study Notes

Cervical Spine Fractures

  • Avulsion fracture of the anterior arch of atlas (C1) occurs when hyperextension force is transmitted through an intact anterior longitudinal ligament and other anterior muscular attachments.
  • Causes transverse fracture of the anterior arch of C1.
  • Best demonstrated on lateral projection.

Posterior Arch of Atlas Fracture

  • Relatively common injury.
  • Caused by C1 being compressed between the occiput and the heavy posterior arch of the axis during severe hyperextension.
  • Not to be confused with Jefferson fracture.
  • No neurological deficit.
  • Stable.

Hyperextension Teardrop Fracture of Axis

  • Small triangular fragment of bone avulsed from the anterior, inferior border of C2.
  • Separate triangular fragment avulsed at the site of insertion of the intact anterior longitudinal ligament.
  • More common in older/osteoporotic patients.

Hangman's Fracture

  • Bilateral C2 pars interarticularis fractures.
  • Anterior subluxation of the C2 vertebral body.
  • Retropulsion of vertebral body fragments can result in neurologic symptoms associated with narrowing of the spinal canal.
  • CT can be used to define the bony anatomy, and MRI to determine the level of spinal cord compression.

Spondylosis

  • Refers to degenerative changes of the discs, vertebral bodies, and facet joints that develop as a result of the aging process.
  • Characteristics include:
    • Disc space narrowing.
    • End plate sclerosis.
    • Osteophytes.
    • Vacuum sign.
    • Schmorl's nodes.
    • Degenerative osteoarthritis of the facet joints.
    • Subchondral cyst formation.

Osteophytes vs. Syndesmophytes

  • Osteophytes:
    • Begin several millimeters from the edge of the vertebral body.
    • Initially oriented horizontally at their attachment to the vertebral bodies.
    • May curve slightly and form a complete bony bridge across the disc space.
  • Syndesmophytes:
    • Due to inflammation and ossification of the outer fibers of the annulus fibrosis, known as Sharpey's fibers.
    • Classically seen in ankylosing spondylitis.

Scoliosis

  • Abnormal lateral curvature of the spine.

Fracture of Transverse Process vs. Spinous Process

  • Fracture of transverse process:
    • More common.
    • Often associated with significant trauma.
  • Fracture of spinous process:
    • Less common.
    • Often associated with trivial trauma.

Chance Fracture

  • Horizontal splitting of the spine and neural arch.
  • Associated with frontal impact seatbelt injury.
  • Seatbelt becomes a fulcrum.

Normal SI Joints

  • Consistent joint space.
  • No osteophytes.
  • No joint margin sclerosis.
  • No bony erosions.
  • No ankylosis.

Sacroiliitis

  • Sclerotic changes.
  • Ill-defined joint margin.
  • Widening of the joint space.

Ankylosing Spondylitis

  • Rheumatic disease that causes arthritis of the spine and sacroiliac joints.
  • Early features include:
    • Squaring of the vertebral bodies.
    • Loss of normal concavity of the anterior border.

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Description

This quiz is about the avulsion fracture of the anterior arch of atlas, its causes, and how it is demonstrated on a lateral projection.

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