Orthopedics Book

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Cervical Spine Fracture

Aka: Cervical Spine Fracture, C-Spine Fracture, Clay Shoveler's Fracture, Odontoid Process Fracture, Hangman's fracture, Jefferson Fracture, Cervical Wedge Compression Fracture, C1 Fracture, C2 Fracture, Cervical Teardrop Fracture, Cervical Spinous Process Fracture, Cervical Burst Fracture, Cervical Facet Dislocation, Cervical Fracture
  1. See Also
    1. Cervical Spine Injury
    2. Pediatric Cervical Spine Injury
    3. Axial Compression of Cervical Spine
  2. Anatomy
    1. See Cervical Spine Anatomy
    2. Image: Cervical Vertebrae
      1. orthoSpineVertebraeCervicalGrayBB84.gifLewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)
    3. Three-Column Model
      1. Anterior column
        1. Anterior half of Vertebral body
        2. Anterior ligamentous complex
          1. Anterior portion of annulus fibrosus
          2. Anterior longitudinal ligament
      2. Middle column
        1. Posterior half of Vertebral body
        2. Ligaments
          1. Posterior portion of annulus fibrosus
          2. Posterior longitudinal ligament
      3. Posterior Column
        1. Facet joints (superior and inferior articular process)
        2. Laminae
        3. Spinous processes
        4. Posterior ligamentous complex
          1. Facet capsules
          2. Interspinous ligaments
  3. Types: C1 Fractures
    1. Mechanism
      1. Axial load or Hyperextension injuries
    2. Jefferson Fracture (most common)
      1. Bilateral burst Fracture through posterior arch and lateral aspects
      2. Neurologic function is often spared
  4. Types: C2 Fractures
    1. Arch Fractures (hyperextension injury)
      1. Hangman's fracture (now typically due to MVAs)
        1. Fracture through both arches, pedicles
        2. C2 is dislocated from C1, and C2 subluxes anteriorly on C3
    2. Odontoid Fractures (forced flexion or extension)
      1. Fracture at junction of odontoid and Vertebral body
        1. Surgically managed
      2. Fracture of the odontoid tip
        1. Managed with Cervical Collar immobilization
  5. Types: Facet Dislocation
    1. Unilateral facet dislocation
      1. Results from axial load with flexion and rotation
      2. Partial Vertebral subluxation <50% of Vertebral body width
      3. Stable injury
    2. Bilateral facet dislocation
      1. Severe flexion force to the middle and Posterior Columns
      2. Vertebral subluxation >50% of Vertebral body width
      3. Unstable injury
  6. Types: Wedge Compression Fracture
    1. Mechanism
      1. Flexion loading of the spine (even minor forces)
    2. Anterior Vertebral body end plate compression
      1. Posterior Vertebral height maintained (<25% wedge compression)
        1. Typically stable Fracture
        2. Evaluate with flexion-extension views for subluxation
      2. Posterior Vertebral height compressed more than 25%
        1. Associated with posterior ligamentous complex disruption
  7. Types: Flexion Teardrop Fracture
    1. Mechanism
      1. Flexion and compression injury (e.g. diving)
    2. Fracture dislocation which is highly unstable
      1. Small anteroinferior teardrop Fracture fragment
      2. Vertebral body or facet subluxation or spine angulation
  8. Types: Burst Fracture
    1. Mechanism
      1. Flexion and compression injury (e.g. diving)
    2. Comminuted Vertebral Fracture
      1. Disrupts anterior and middle columns
      2. Typically involves middle and lower Cervical Vertebrae
      3. Spinal cord injury if fragments are displaced
  9. Types: Spinous Process Fracture
    1. Mechanisms
      1. Direct spinous process Trauma
      2. Sudden deceleration
      3. High velocity Trauma with neck flexion
      4. Severe muscle contraction with secondary avulsion
    2. Spinous process tip avulsion (Clay Shoveler's Fracture)
      1. Occurs at C6 or C7
      2. Related to strong pull from neck and Shoulder muscles with heavy physical work
      3. Stable Fracture (but confirm with flexion-extension XRay views)
      4. Differential Diagnosis
        1. Fracture of base of spinous process (disrupts posterior ligamentous complex)
        2. Nonfused, spinous process apophysis
  10. Imaging
    1. See Acute Cervical Spine Imaging
  11. Management
    1. See Cervical Spine Injury
    2. See Cervical Spine Immobilization
    3. Vertebral Fracture Stability
      1. Consider any cervical Vertebral Fracture unstable with the exception of those listed below
      2. Unstable Cervical Spine Fracture (Mnemonic - "Jefferson Bit Off A Hangman's Tit")
        1. J - Jefferson Fracture (C1 Burst Fracture)
        2. B - Bifacet dislocation or Fracture
        3. O - Odontoid Fracture (Types 2 and 3)
        4. A - Any Fracture-dislocation
        5. H - Hangman's fracture (posterior C2 Fracture)
        6. T - Teardrop Fracture
      3. Stable Fractures
        1. Spinous process Fracture
        2. Transverse process Fracture
        3. Unilateral facet dislocation
        4. Wedge Fracture (unless posterior Vertebral height compressed more than 25%)
        5. Vertebral burst Fracture (except C1 Jefferson Fracture, or if fragments are retropulsed)
  12. References
    1. Eiff and Hatch (2018) Fracture Management for Primary Care, p. 187-96

Fracture of cervical spine (C0262414)

Concepts Injury or Poisoning (T037)
ICD10 S12, S12.9
SnomedCT 207982008, 125606003
English Fracture of neck, part unspecified, Fractured cervical spine, Fracture of neck NOS, Fracture of cervical vertebra NOS, fracture of neck, Fracture of cervical spine NOS, cervical spine fracture, cervical vertebra fracture, fracture neck, Fracture;cervical, cervical fractures, fracture neck of, neck fracture, Fracture;neck, fractures neck, cervical fracture, cervical fractures spine, fracture cervical, fracture cervical vertebra, Cervical vertebral fracture, fracture of cervical spine (diagnosis), Fracture of cervical spine, Fracture of neck, Fracture of cervical spine (disorder), Fracture of cervical vertebra, cervical; fracture, fracture; cervical, fracture; neck, fracture; spine or vertebra, cervical, fracture; vertebra, cervical, neck; fracture, spine or vertebra; fracture, cervical, fracture of cervical spine, fractured neck
Italian Frattura della vertebra cervicale, Colonna cervicale fratturata
Dutch gefractureerd cervicale wervelkolom, cervicaal; fractuur, fractuur; cervicaal, fractuur; hals, fractuur; wervel, cervicaal, fractuur; wervel{kolom}, cervicaal, hals; fractuur, wervel{kolom}; fractuur, cervicaal, Fractuur van hals, deel niet gespecificeerd, halswervelbreuk, Fractuur van hals
French Rachis cervical fracturé, Fracture de vertèbre cervicale
German Fraktur der Halswirbelsaeule, Fraktur im Bereich des Halses, Teil nicht naeher bezeichnet, Fraktur im Bereich des Halses, Fraktur eines Halswirbels
Portuguese Coluna vertebral fracturada, Fractura de vértebra cervical
Spanish Columna cervical fracturada, fractura de las vértebras cervicales, fractura de la columna vertebral cervical (trastorno), fractura de la columna vertebral cervical, fractura del cuello, Fractura de la vertebra cervical
Japanese 頚椎骨折, ケイツイコッセツ
Czech Zlomená krční páteř, Zlomenina krčního obratle
Korean 목의 골절, 상세불명의 목 부분의 골절
Hungarian Nyakcsigolyatörés, Nyakigerinctörés
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Fracture of first cervical vertebra (C0349012)

Concepts Injury or Poisoning (T037)
ICD10 S12.0
SnomedCT 207983003
English Fracture/1st cervical vertebra, Atlas, Fracture of first cervical vertebra, fracture of first cervical vertebra (diagnosis), Fracture of first cervical vertebra (disorder), atlas; fracture, fracture; atlas, fracture; spine or vertebra, atlas, fracture; spine or vertebra, cervical, first (atlas), spine or vertebra; fracture, atlas, spine or vertebra; fracture, cervical, first (atlas)
German Fraktur des 1. Halswirbels
Korean 제1목척추뼈의 골절
Dutch atlas; fractuur, fractuur; atlas, fractuur; wervel{kolom}, atlas, fractuur; wervel{kolom}, cervicaal, eerste (atlas), wervel{kolom}; fractuur, atlas, wervel{kolom}; fractuur, cervicaal, eerste (atlas), Fractuur van eerste cervicale wervel
Spanish fractura de la primera vértebra cervical (trastorno), fractura de la primera vértebra cervical
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Fracture of second cervical vertebra (C0349013)

Concepts Injury or Poisoning (T037)
ICD10 S12.1
SnomedCT 207984009
English Fracture/2nd cervical vertebra, Axis, Fracture of second cervical vertebra, fracture of second cervical vertebra (diagnosis), Fracture of second cervical vertebra (disorder), axis; fracture, fracture; axis, fracture; spine or vertebra, axis, fracture; spine or vertebra, cervical, second (axis), spine or vertebra; fracture, axis, spine or vertebra; fracture, cervical, second (axis)
German Fraktur des 2. Halswirbels
Korean 제2목척추뼈의 골절
Dutch axis; fractuur, fractuur; axis, fractuur; wervel{kolom}, cervicaal, tweede (draaier), fractuur; wervel{kolom}, draaier, wervel{kolom}; fractuur, cervicaal, tweede (draaier), wervel{kolom}; fractuur, draaier, Fractuur van tweede cervicale wervel
Spanish fractura de la segunda vértebra cervical (trastorno), fractura de la segunda vértebra cervical
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Hangman's fracture (C0434858)

Concepts Injury or Poisoning (T037)
SnomedCT 263070009
English Hangman fracture, Hangman's fracture (diagnosis), fracture of pedicle cervicle spine hangman's, Hangman's fracture, Hangman's fracture (disorder)
Spanish fractura de Hangman (trastorno), fractura de Hangman
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Jefferson fracture (C0435351)

Concepts Injury or Poisoning (T037)
SnomedCT 263180005
Dutch atlasfractuur
French Fracture de Jefferson
German Jefferson-Fraktur
Italian Frattura di Jefferson
Portuguese Fractura de Jefferson
Spanish Fractura de Jefferson, fractura de Jefferson (trastorno), fractura de Jefferson, fractura del arco del atlas
Japanese ジェファーソン骨折, ジェファーソンコッセツ
Czech Jeffersonova zlomenina
English Jefferson's fracture, fracture jeffersons, jefferson's fracture, fractures jefferson, jefferson fracture, fracture of first cervical vertebra jefferson, fracture of first cervical vertebra jefferson (diagnosis), Jefferson fracture, Fracture arch of atlas, Jefferson fracture (disorder)
Hungarian Jefferson-féle törés
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Fracture of odontoid process (C0559777)

Concepts Injury or Poisoning (T037)
SnomedCT 281910003
English odontoid fracture, Fracture of odontoid peg, Fracture of odontoid process, fracture of odontoid process, dens fracture of second cervical vertebral body (diagnosis), dens fracture of second cervical vertebral body, fracture of second cervical vertebra, odontoid process (diagnosis), fracture of second cervical vertebra, odontoid process, Fracture of odontoid peg (disorder), fracture; odontoid process, process; odontoid, fracture
Dutch fractuur; processus odontoideus, processus; odontoideus, fractuur
Spanish fractura de apófisis odontoides (trastorno), fractura de apófisis odontoides
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Teardrop fracture of cervical vertebra (C0559778)

Concepts Injury or Poisoning (T037)
SnomedCT 281911004
English Tear drop fract cervical vert, Tear drop fracture of cervical vertebra, fracture teardrop of cervical vertebra (diagnosis), fracture teardrop of cervical vertebra, Teardrop fracture of cervical vertebra (disorder), Teardrop fracture of cervical vertebra
Spanish fractura en lágrima de vértebra cervical, fractura en gota de lágrima de vértebra cervical (trastorno), fractura en gota de lágrima de vértebra cervical, fractura en lágrima de vértebra cervical (trastorno)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Wedge fracture of cervical vertebra (C0559779)

Concepts Injury or Poisoning (T037)
SnomedCT 281912006
English Collapse fract cervic vertebra, Wedge fract cervical vertebra, wedge fracture of cervical vertebral body, wedge fracture of cervical vertebral body (diagnosis), Collapse wedge fracture of cervical vertebra, Wedge fracture of cervical vertebra, Wedge fracture of cervical vertebra (disorder)
Spanish fractura en cuña de vértebra cervical (trastorno), fractura en cuña de vértebra cervical, fractura en cuña por compresión de vértebra cervical
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Burst fracture of cervical vertebra (C0559781)

Concepts Injury or Poisoning (T037)
SnomedCT 281914007
English Burst fract cervical vertebra, burst fracture of cervical vertebral body, burst fracture of cervical vertebral body (diagnosis), Burst fracture of cervical vertebra, Burst fracture of cervical vertebra (disorder)
Spanish fractura por estallido de vértebra cervical (trastorno), fractura por estallido de vértebra cervical
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Fracture of spinous process of cervical vertebra (C0559785)

Concepts Injury or Poisoning (T037)
SnomedCT 281918005
English Fract spin proc cervical vert, fracture of spinous process of cervical vertebra (diagnosis), Fracture of spinous process of cervical vertebra, Fracture of spinous process of cervical vertebra (disorder)
Spanish fractura de apófisis espinosa de vértebra cervical (trastorno), fractura de apófisis espinosa de vértebra cervical
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Dislocation of cervical facet joint (C1281992)

Concepts Injury or Poisoning (T037)
SnomedCT 314195000
English dislocation cervical vertebra facet joint, Dislocation of cervical facet joint (diagnosis), Dislocation of cervical facet joint (disorder), Dislocation of cervical facet joint
Spanish luxación de articulación cigoapofisaria cervical (trastorno), luxación de articulación cigoapofisaria cervical
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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