Identifying Fracture-Dislocation in Radiology

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Questions and Answers

What is the name of the fracture described in the text?

Avulsion injury of the spinous process
Clay-shoveller’s fracture (correct)
Severe fracture-dislocation
Fracture of the C7 spinous process

What is the main cause of the clay-shoveller’s fracture?

Fracture of the C7 spinous process
Weakened neck muscles
Whiplash injury
Severe voluntary contraction of the muscles at the back of the neck (correct)

What is the severity of the clay-shoveller’s fracture?

Mild and requires physical therapy
Severe and life-threatening
Painful but harmless (correct)
Moderate and requires surgery

What is the treatment for the clay-shoveller’s fracture?

Immediate treatment is not required (B) Signup and view all the answers

Which gender is more likely to experience the avulsion injury of the spinous process?

Women (C) Signup and view all the answers

What is the probable reason for the avulsion injury of the spinous process in women?

More gracile neck muscles (C) Signup and view all the answers

What is the correlation between the amount of damage to the vehicle and the severity of complaints from occupants?

No correlation (B) Signup and view all the answers

What is the probable pathology of the avulsion injury of the spinous process?

Strain on the anterior longitudinal ligament (C) Signup and view all the answers

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 (A) Signup and view all the answers

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 (A) Signup and view all the answers

What is the term used to describe a whiplash injury?

Whiplash injury (B) Signup and view all the answers

What is the purpose of the severity grading system proposed by the Quebec Task Force?

To compare the severity of whiplash injuries (D) Signup and view all the answers

Which of the following is a symptom of a Grade 1 whiplash injury?

Neck pain, stiffness and tenderness (C) Signup and view all the answers

What is a predisposing factor for neurapraxia of the cervical cord?

Congenital narrowing of the spinal canal (D) Signup and view all the answers

Why are women more often affected by whiplash injuries?

They are more prone to bruising of the chest (D) Signup and view all the answers

What can cause symptoms resembling those of a whiplash injury?

All of the above (D) Signup and view all the answers

What is the primary treatment for sprained neck?

Reassurance and graded exercises (A) Signup and view all the answers

Why should X-rays be carefully scrutinized?

To identify vertebral fractures or midcervical subluxation (C) Signup and view all the answers

What is the term used to describe the chronic condition that results from a whiplash injury?

Whiplash-associated disorder (A) Signup and view all the answers

What is an indication for MRI?

Presence of neurological signs (A) Signup and view all the answers

What often accompanies neck sprains?

Seat-belt injuries (D) Signup and view all the answers

What is the primary means of diagnosing sprained neck?

Process of exclusion (A) Signup and view all the answers

What happens if an acute fracture is left untreated?

It will heal spontaneously (C) Signup and view all the answers

What is the treatment for unilateral pars fractures?

Conservative treatment (C) Signup and view all the answers

What is the indication for posterior fixation?

Unstable injury (A) Signup and view all the answers

What is the significance of sclerosis and 'cold' on isotope scan in pars fractures?

Indicates non-union (D) Signup and view all the answers

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 (B) Signup and view all the answers

What is the role of MRI scan in the diagnosis of unstable injuries?

To confirm PLC disruption (C) Signup and view all the answers

What is the significance of corticalization and 'rounding off' of the fracture on CT?

Indicates chronicity and non-union (A) Signup and view all the answers

Why may pars fractures not heal with rest alone?

Due to chronicity and sclerosis (B) Signup and view all the answers

What is the likely outcome of severe axial compression?

Explosion of the vertebral body (A) Signup and view all the answers

What indicates likelihood of spinal instability?

Disruption of the posterior ligamentous complex (A) Signup and view all the answers

What may be seen on Anteroposterior X-rays in burst injuries?

Spreading of the vertebral body (A) Signup and view all the answers

What is the significance of PLC integrity in axial compression injury?

It determines the stability of the injury (A) Signup and view all the answers

What is the characteristic of the posterior vertebral body in burst injuries?

Convex shape (A) Signup and view all the answers

What may be displaced into the spinal canal in burst injuries?

Both bone and disc fragments (A) Signup and view all the answers

What is the management of stable compression fractures?

Conservative management with a plaster jacket or lightweight removable orthosis (D) Signup and view all the answers

What is the treatment for unstable compression fractures with PLC disruption?

Posterior internal fixation (C) Signup and view all the answers

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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

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