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Unstable spine fractures
From WikEM
Contents
Background
Denis' three column concept helps to determine whether a vertebral fracture is stable or unstable
- I: Anterior column
- Anterior longitudinal ligament
- Anterior 1/2 of the vertebral body and disk
- II: Middle column
- Posterior 1/2 of the vertebral body and disk
- Posterior longitudinal ligament
- III: Posterior column
- Facet joints
- Ligament flavum
- Posterior elements
Clinical Features
- I:Always stable
- II:Possibly unstable
- III:Always unstable
Example of Unstable Fractures
- Jefferson's fracture
- Bilateral Cervical facet dislocation
- Odontoid fracture, type II or III
- Atlanto-occipital dissociation
- Hangman's fracture
- Flexion teardrop
- Mnemonic: "Jefferson Bit Off A Hangman's Thumb"
Workup
- CT with reconstructions
- Consider plain x-ray in conjunction as this is what is used during orthospine follow up
- MRI to assess cord and ligament damage
Management
- C-collar
- Consult ortho or spine as needed
See Also
- Cervical Spine Injuries
- Spinal Cord Trauma
- Spinal Cord Compression (Non-Traumatic)
- Neurogenic Shock
- C-spine (NEXUS)
- C-Spine X-Ray
- Fractures (Main)
References
Authors
Neil Young, Ross Donaldson, Jonathan Osgood, Daniel Ostermayer
