38 Questions
What is the name of the fracture described in the text?
Clay-shoveller’s fracture
What is the main cause of the clay-shoveller’s fracture?
Severe voluntary contraction of the muscles at the back of the neck
What is the severity of the clay-shoveller’s fracture?
Painful but harmless
What is the treatment for the clay-shoveller’s fracture?
Immediate treatment is not required
Which gender is more likely to experience the avulsion injury of the spinous process?
Women
What is the probable reason for the avulsion injury of the spinous process in women?
More gracile neck muscles
What is the correlation between the amount of damage to the vehicle and the severity of complaints from occupants?
No correlation
What is the probable pathology of the avulsion injury of the spinous process?
Strain on the anterior longitudinal ligament
What is the typical mechanism of injury that occurs in a whiplash injury?
A low-velocity rear-end collision with the body forced against the car seat
What is the condition called when there is pinching of the cord by the bony edges of the mobile spinal canal?
Neurapraxia of the cervical cord
What is the term used to describe a whiplash injury?
Whiplash injury
What is the purpose of the severity grading system proposed by the Quebec Task Force?
To compare the severity of whiplash injuries
Which of the following is a symptom of a Grade 1 whiplash injury?
Neck pain, stiffness and tenderness
What is a predisposing factor for neurapraxia of the cervical cord?
Congenital narrowing of the spinal canal
Why are women more often affected by whiplash injuries?
They are more prone to bruising of the chest
What can cause symptoms resembling those of a whiplash injury?
All of the above
What is the primary treatment for sprained neck?
Reassurance and graded exercises
Why should X-rays be carefully scrutinized?
To identify vertebral fractures or midcervical subluxation
What is the term used to describe the chronic condition that results from a whiplash injury?
Whiplash-associated disorder
What is an indication for MRI?
Presence of neurological signs
What often accompanies neck sprains?
Seat-belt injuries
What is the primary means of diagnosing sprained neck?
Process of exclusion
What happens if an acute fracture is left untreated?
It will heal spontaneously
What is the treatment for unilateral pars fractures?
Conservative treatment
What is the indication for posterior fixation?
Unstable injury
What is the significance of sclerosis and 'cold' on isotope scan in pars fractures?
Indicates non-union
What is the preferred treatment for patients with wedge compression fracture and neurological impairment?
Depends on stability of injury and risk of kyphotic deformity progression
What is the role of MRI scan in the diagnosis of unstable injuries?
To confirm PLC disruption
What is the significance of corticalization and 'rounding off' of the fracture on CT?
Indicates chronicity and non-union
Why may pars fractures not heal with rest alone?
Due to chronicity and sclerosis
What is the likely outcome of severe axial compression?
Explosion of the vertebral body
What indicates likelihood of spinal instability?
Disruption of the posterior ligamentous complex
What may be seen on Anteroposterior X-rays in burst injuries?
Spreading of the vertebral body
What is the significance of PLC integrity in axial compression injury?
It determines the stability of the injury
What is the characteristic of the posterior vertebral body in burst injuries?
Convex shape
What may be displaced into the spinal canal in burst injuries?
Both bone and disc fragments
What is the management of stable compression fractures?
Conservative management with a plaster jacket or lightweight removable orthosis
What is the treatment for unstable compression fractures with PLC disruption?
Posterior internal fixation
Study Notes
Fracture Types
- Avulsion injury of the spinous process: Fracture of the C7 spinous process may occur with severe voluntary contraction of the muscles at the back of the neck, known as the clay-shoveller’s fracture.
- Whiplash injury (sprained neck / cervical acceleration-deceleration injury): Soft-tissue sprains of the neck common after motor vehicle accidents, often occurring with low-velocity rear-end collisions.
Whiplash Injury Symptoms and Grading
- Symptoms: Neck pain, stiffness, and tenderness
- Grading system proposed by the Quebec Task Force on whiplash-associated disorders:
- Grade 0: No neck symptoms or signs
- Grade 1: Neck pain, stiffness, and tenderness, with no physical signs
- Grade 2: Neck symptoms and musculoskeletal signs
- Grade 3: Neck symptoms and neurological signs
- Grade 4: Neck symptoms and fracture or dislocation
Whiplash Injury Treatment and Diagnosis
- Treatment: Reassurance, graded exercises to improve neck muscle strength
- Diagnosis: Differential diagnosis by process of exclusion, with X-rays scrutinized to avoid missing vertebral fracture or midcervical subluxation
- Indications for MRI: Presence of neurological signs (muscle weakness, wasting, depressed reflex, loss of sensibility)
Pars Fractures
- Treatment: Unilateral pars fractures usually heal spontaneously, but chronic fractures with sclerosis and 'cold' on isotope scan have little chance of healing with rest alone
- Imaging: CT scan to confirm chronicity and non-union
- Figure 28.28: Pars defect with corticalization and rounding off of the fracture indicates chronicity and non-union
Axial Compression or Burst Injury
- Description: Severe axial compression causing failure of the anterior vertebral column, with posterior part of the vertebral body shattered and fragments of bone and disc displaced into the spinal canal
- Imaging: Anteroposterior X-rays show spreading of the vertebral body with increased interpedicular distance
- Stability: Depends on posterior ligamentous complex integrity, with posterior displacement of bone into the spinal canal (retropulsion) indicating instability
Analyze radiology images to identify the severity of a fracture. This quiz assesses your understanding of fracture-dislocation and its diagnosis.
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