7. Complete the following:

G7 p.932:80mm

a. Due to ligamentous laxity together with immaturity of paraspinal muscles and underdeveloped uncinate processes, pediatric spinal injury tends to involve_____ types of injury.

ligamentous

b. In the age group ≤ 9 years, the_____ spine is the most vulnerable segment.

cervical

c. In cervical spine injuries in the pediatric population, 67% occur in the_____ segments of the cervical spine.

upper 3 (occiput-C2)

8. Complete the following about pediatric spine injuries:

G7 p.933:50mm

a. “Pseudospread of the atlas” is a phenomenon occurring in_____.

children

b. It could be confused with_____ _____.

Jefferson fracture

9. Answer the following about Jefferson fractures:

G7 p.933:70mm

a. True or False. Jefferson fractures are common in pediatric cervical spine injury.

false

b. They are more common during the _____ years.

teenage

10. Complete the following:

G7 p.933:135mm

a. The major causes of death in spinal cord injury are

     i. _____and

aspiration

     ii. _____.

shock

b. Associated findings suggestive of spinal cord injury include

     i.   _____ _____ and

abdominal breathing

     i.  _____.

priapism (autonomic dysfunction)

11. True or False. In caring for an injured athlete, prompt removal of the helmet is recommended.

false (Do not remove the helmet in the field—National Athletic Trainers Association [NATA] guidelines.)

G7 p.934:90mm

12. Complete the following:

G7 p.934:125mm

a. In spinal cord injury with hypotension in the field, the agent of choice is_____.

dopamine

b. Avoid_____.

phenylephrine—noninotropic, and possible reflex increase in vagal tone with bradycardia

13. In evaluating spinal cord injury in the field, hypopnea may be related to three conditions:

G7 p.934:175mm

a. paralyzed i_____ m_____

intercostal muscles

b. paralyzed d_____

diaphragm (phrenic nerve = C3, C4, C5)

c. depressed_____

LOC

14. Complete the following:

G7 p.936:26mm

a. True or False. Spinal cord injury can cause loss of temperature regulation.

true

b. This is called p_____

poikilothermy

c. and is caused by v_____ p_____.

vasomotor paralysis

15. Complete the following about initial management of spinal cord injuries:

G7 p936:32mm

a. True or False. Spinal cord injury can cause electrolyte disturbances

true

b. due to

     i. _____and

hypotension

     ii. _____,

hypovolemia

c. which cause an increase in_____ _____,

plasma aldosterone

d. which leads to_____.

hypokalemia

16. Complete the following: (Note: Practice parameter caution regarding use of steroids.)

G7 p.936:165mm

a. In adhering to the spinal cord injury steroid protocol, methylprednisolone needs to be administered within_____ hours of injury to improve outcome.

8

b. What may occur if given later?

worse outcome at 1 year

17. True or False. Methylprednisolone protocol has been shown to be useful for patients with

G7 p.936:177mm

a. cauda equina syndrome

false

b. gunshot wounds to the spine

false

c. children

false

d. pregnant women

false

18. Discuss administration of methylprednisolone protocol in spinal cord injury.

G7 p.937:35mm

a. Initial bolus is _____mg/kg IV.

30

b. Over how long a period of time?

15 minutes

c. Followed by a_____.

45-minute pause

d. Follow with maintenance infusion of_____.

5.4 mg/kg/hr IV

e. Over how long a period of time?

G7 p.937:73mm

     i. If started within 3 hours of injury,_____ hours.

23

     ii. If started between 3 and 8 hours,_____ hours.

47

19. True or False. Regarding deep vein thrombosis (DVT) in spinal cord injury (SCI):

G7 p.937:130mm;

a. Heparin 5000 U subcutaneous (SQ) twice a day is more effective than SQ heparin to titrate partial thromboplastin time (PTT) to 1.5 times normal.

false (Better to titrate SQ heparin to PTT 1.5 times control.)

b. Pneumatic boots should be used initially.

true

20. Complete the following about spinal cord injury and deep vein thrombosis:

G7 p.637:132mm

a. incidence _____%

100%

b. mortality _____%

9%

c. prevent with _____ _____ boots

pneumatic compression

d. and subcutaneous_____

heparin

e. preferably titrated to a partial thromboplastin time (PTT) of_____

1.5 times control

f. What medication can cause thrombocytopenia and osteoporosis?

heparin

21. Matching. In assessing C-spine in these categories of trauma patient, perform the following tests:

G7 p.938:73mm

Test to perform:

none needed; CT from occiput to T1; plain C-spine x-rays; flexion-extension; MRI

Category of trauma patient:

a. Alert, denies neck pain

b. Alert, complains of neck pain

c. Obtunded or inebriated

d. Abnormal CT

e. Neurological deficit

and

22. When do we do

G7 p.938:148mm

a. Plain C-spine x-ray? If_____ is no available

CT

b. Flexion extension views

     i. in an_____ patient

alert

     ii. who complains of_____ _____

neck pain

     iii. and in whom_____ is normal

CT

     iv. and_____ is not available

MRI

23. Factors associated with increased risk of failing to recognize spinal injuries during radiographic evaluation include

G7 p.939:49mm

a. decreased_____ of_____

level of consciousness

b. multiple_____

injuries

c. inadequate_____

x-rays (technically)

24. Radiographic signs of C-spine trauma include

G7 p.939:80mm

a. retropharyngeal space >_____ mm

7 mm

b. retrotracheal space >_____ mm in adult

14 mm

c. or >_____ mm in pediatrics

22 mm

d. atlantodental interval (ADI) >_____ mm in adult

3 mm

e. >_____ mm in pediatrics

4 mm

f. In the neurologically intact patient, subluxation up to_____ mm may be normal.

3.5 mm

g. To prove it is normal do_____.

flexion-extension views

25. When should we order anteroposterior (AP) and lateral views of the thoracic and lumbosacral spine?

G7 p.940:90mm

Hint: btuf

a. b_____

back pain complaints

b. t_____

thrown from a vehicle

c. u_____

unconscious

d. f_____

fell more than 6 feet

26. Complete the following:

G7 p.940:115mm

a. How can we tell an old injury from an acute one?

bone scan

b. We should test between_____ and_____ days.

2 and 21 days

c. Test will remain abnormal for_____ _____.

1

27. During evaluation of occult cervical spine trauma, what are the contraindications for flexion-extension cervical spine x-rays?

G7 p.940:58mm

a. patient who is not_____

cooperative

b. patient who has_____ impairment

mental

c. subluxation of_____ or more

3.5 mm

d. neurologic deficit of_____

any degree

28. True or False. A normal flexion-extension study of the cervical spine x-ray may demonstrate slight anterior subluxation distributed over all cervical levels with preservation of the normal contour lines.

true

G7 p.941:35mm

29. Complete the following:

G7 p.941:77mm

a. Lumbar puncture is dangerous in complete spinal block and may cause deterioration in _____%.

14%

b. Avoid this with a_____ or_____.

lateral cervical puncture or MRI

30. Indications for emergent myelogram or magnetic resonance imaging (MRI) in spinal cord injury includes neurologic deficit

G7 p.941:98mm

a. that is not_____

explained

b. after closed_____

reduction

c. after _____surgery

spinal

31. Complete the following about MRI in spine:

G7 p.941:147mm

a. It is appropriate when

     i. CT of spine is_____.

inconclusive

     ii. patient has neurological_____.

deficits

b. It should be done within_____ hours.

48 to 72

c. Most useful sequences are

     i. _____and

T2W1

     ii. F_____.

FLAIR

32. Contraindications to traction/reduction of cervical spine injuries include

G7 p.942:95mm

a. atlanto-occipital_____

dislocation

b. types of axis fractures called_____ or_____

type II A, or III hangman’s fracture

c. a defect in the_____

skull at an anticipated pin site

d. the patient is less than _____ years of age

3

33. Complete the following:

G7 p.943:90mm

a. After placing the patient in tongs we must obtain a_____

lateral cervical spine x-ray

b. and measure the distance between the

     i. _____and the

basion

     ii. _____,

odontoid

c. which should be less than_____ mm in adults

2 mm

d. and less than_____ mm in children.

10 mm

34. What is considered proper pin care?

G7 p.943:117mm

a. Clean with_____.

half-strength hydrogen peroxide

b. Apply_____.

povidone-iodine

c. This may reduce the incidence of_____.

osteomyelitis

35. Complete the following:

G7 p.943:75mm

a. Closed reduction of cervical dislocations may be associated with neurologic deterioration, and this may be due to a r_____ c_____ d_____.

retropulsed cervical disc

b. If neurologic deterioration occurs after closed reduction what tests must you do immediately?

     i. l_____ c_____ p_____

lateral cervical puncture followed by myelogram/CT MRI

     ii.  _____

36. Complete the following:

G7 p.944:50mm

a. True or False. Patient with recent onset of loss of function due to spinal cord injury should have a decompressive laminectomy.

false (Recent acute injury is not the time for surgery; it may be associated with neurologic deterioration.)

b. If surgery is done it is usually combined with_____.

a stabilization procedure

37. Contraindications to emergent operation for acute spinal cord injury include

G7 p.944:140mm

a. complete_____ _____ _____ for more than 24 hours

spinal cord injury

b. unstable_____

medically

c. central_____ _____

cord syndrome

38. Complete the following:

G7 p.944:180mm

a. Cervical nerves exit_____ their like-numbered vertebra.

above

b. Thoracic and lumbar nerves exit _____ their like-numbered vertebra.

below

c. For a segment of cord that lies under a given vertebra T2 to T10 add_____ _____ _____.

two cord levels

G7 p.945:30mm

d. Under T11, T12, L1 lie the_____.

lowest 11 spinal segments

e. The conus lies behind_____.

L1 or L2

39. Give the location of the key sensory landmarks.

G7 p.945:55mm

a. occipital protuberance

C2

b. supraclavicular fossa

C3

c. shoulders

C4

d. lateral side of antecubital fossa

C5

e. thumb

C6

f. middle finger

C7

g. little finger

C8

h. medial side of antecubital fossa

T1

     i. nipples

T4

j. xyphoid

T6

k. umbilicus

T10

l. inguinal ligament

T12

m. medial femoral condyle

L3

n. medial maleolus

L4

o. great toe

L5

p. lateral maleolus

S1

q. popliteal fossa in midline

S2

r. ischial tuberosity

S3

s. perianal area

S4-5

40. Write out the American Spinal Injury Association (ASIA) motor scoring system—upper extremity—for the indicated root, muscle, and action to test.

G7 p.945:55mm

a. root C5

     i. muscle: d_____ or b_____

deltoid or biceps

     ii. action: s_____ a_____ or_____ e_____ f_____

shoulder abduction or elbow flexion

b. root C6

     i. muscle: w_____ e_____

wrist extensors

     ii. action: e_____ w_____

extend wrist

c. root C7

     i. muscle: t_____

Triceps

     ii. action: e_____ e_____

extend elbow

d. root C8

     i. muscle: f_____ d_____ p_____

flexor digitorum profundus

     ii. action: s_____ h_____

squeeze hand

e. root T1

     i. muscle: h_____ i_____

hand intrinsics

     ii. action: a_____ l_____ f_____

abduct little finger

41. Write out the ASIA motor scoring system—lower extremity—for the indicated root, muscle, and action to test.

G7 p.945:56mm

a. root L2

     i. muscle: i_____

iliopsoas

     ii. action: f_____ h_____

flex hip

b. root L3

     i. muscle: q_____

quadriceps

     ii. action: s_____ k_____

straight knee

c. root L4

     i. muscle: t_____ a_____

tibialis anterior

     ii. action: d_____ f_____

dorsiflex foot

d. root L5

     i. muscle: e_____ h_____ l_____

extensor hallucis longus (EHL)

     ii. action: d_____ g_____ t_____

dorsiflex great toe

e. root S1

     i. muscle: g_____

gastrocnemius

     ii. action: p_____ f_____ f_____

plantar flex foot

42. Matching. Match the main nerve root responsible for the following motor action:

G7 p. 946:45mm

Nerve root:

L3;L4;L5;S1

Motor action:

a. great toe extension

(+S1)

b. ankle dorsiflexion

(+L5)

c. knee extension

(+L4)

d. ankle plantar flexion

(+S2)

43. Complete the following regarding Beevor sign:

G7 p.946:75mm

a. It tests the level of spinal cord injury at about T_____.

T9

b. It is performed by

     i. flexing the_____.

neck

     ii. Note that the_____ moves cephalad.

umbilicus

44. Complete the following regarding the abdominal cutaneous reflex:

G7 p.946:83mm

a. The upper quadrant is served by_____.

T8-9

b. The lower quadrant is served by_____.

T10-11-12

c. Its presence indicates (at least some) function of the_____ _____.

spinal cord

d. There is_____ _____ spinal cord injury

no complete

e. because the reflex_____ to the_____ and then _____to the abdominal muscles.

ascends to the cortex and then descends

45. Complete the following about priapism:

G7 p.946:108mm

a. After spinal cord trauma it indicates injury to the_____ tone

sympathetic

b. and a dominance of_____ tone.

parasympathetic

c. Priapism indicates_____ prognosis for spinal cord recovery of function.

poor

46. There is a sensory region that is not represented on the trunk.

G7 p.946:148mm

a. It jumps from C_____ to T_____.

C4 to T2

b. These levels are distributed exclusively on the u_____ e_____.

upper extremities

47. Give the motor and sensory descriptions for each class in the ASIA impairment scale as modified from the Frankel neurologic performance scale.

G7 p.947:120mm

a. class A

     i. motor

no motor

     ii. sensory

no sensory, (class A= complete motor and sensory paralysis below lesion)

b. class B

     i. motor

no motor

     ii. sensory

some sensory, (class B = complete motor paralysis,some residual sensory perception below lesion)

c. class C

     i. motor

useless motor

     ii. sensory

good sensory, (class C = residual motor function but no practical use)

d. class D

     i. motor

some motor

     ii. sensory

good sensory, (class D = useful but subnormal motor function below lesion)

e. class E

     i. motor

good motor

     ii. sensory

good sensory (class E = normal)

48. True or False. Regarding central cord injuries:

G7 p.948:85mm

a. They usually result from a hyperflexion injury.

false (hyperextension)

b. Motor deficit is greater in the arms than legs.

true

c. Hyperpathia is uncommonly seen.

false (Hyperpathia is commonly seen.)

d. It is the most common type of incomplete spinal injury.

true

G7 p.948:140mm

e. The cord’s centermost region is a watershed zone.

true

f. Somatotopic organization places fibers to lower extremities more medial.

false (more lateral)

g. BP must be maintained at an MAP of 85 to 90 for at least 1 week.

true

G7 p.949:107mm

h. Prompt surgery for decompression is advised.

false

49. A 45-year-old alcoholic male trips and falls, briefly losing consciousness. He was unable to move for 15 minutes, but currently complains only of weakness of both hands. He has an abrasion of his forehead. Computed tomographic (CT) scan of his head was negative. X-ray of C-spine reveals only spondylosis. True or False. Regarding this lesion:

G7 p.949:140mm

a. It has the best prognosis of all incomplete spinal cord injuries.

false (Brown-Séquard has the best prognosis.)

b. There may be sparing of sensation around the anus with an intact voluntary anal sphincter.

true

c. Immediate surgery is recommended even for patients without spinal instability.

false

d. Urinary catheterization is recommended for patients in spinal shock.

true

50. Complete the following about surgical intervention in patients who have had a central spinal cord injury:

G7 p.949:140mm

a. Indications for surgical intervention are

     i. spine_____

instability

     ii. continued spinal cord compression in a patient who fails to_____ or_____

improve or deteriorates

b. What surgery should be done?

decompressive laminectomy and lateral mass or pedicle screw fixation and fusion

51. What is the prognosis in patients with central cord injury?

G7 p.950:82mm

a. _____% will recover enough to ambulate.

50%

b. Bowel and bladder function_____.

recovers

c. Upper extremities (do/don’t)_____ recover well.

don’t

d. Elderly patients (do/don’t)_____ recover well.

don’t

52. Answer the following about anterior cord syndrome:

G7 p.950:105mm

a. True or False. Motor findings are of hemiplegia below the lesion.

false (paraplegia)

b. True or False. There is loss of pain sensation, with preservation of deep pressure sensation.

true (deep pressure sensation is via posterior columns)

c. It may result from_____.

occlusion of anterior spinal artery

d. Sensory pattern is termed “dissociated” because there is loss of

     i. _____ _____ and preservation of

spinothalamic tract

     ii. _____ _____ _____.

posterior column function

53. Answer the following about a Brown-Séquard syndrome:

G7 p.950:116mm

a. True or False. There is contralateral pain loss beginning 1 to 2 levels above the lesion.

false (Pain loss is 1 to 2 levels below the lesion.)

b. True or False. Contralateral position sense is preserved.

true

c. Prognosis compared with all other incomplete cord lesions is_____.

best of all the incomplete cord lesion types

d. What% will eventually walk?

90%

54. Complete the following:

G7 p.951:156mm

a. Incidence in spinal injury is approximately_____%.

1%

b. Are they more common in pediatrics or in adults?

pediatrics (twice as common)

c. Mortality results from_____ _____ _____ _____.

respiratory arrest causing anoxia

55. Complete the following about the three types of atlanto-occipital dislocation:

G7 p.952:17mm

a. Type I: occiput in relation to atlas is dislocated_____.

anteriorly

b. Type II: occiput in relation to atlas is dislocated_____.

longitudinally distracted

c. Type III: occiput in relation to atlas is dislocated_____.

posteriorly

56. Name the ligaments at the following sites:

G6p.718:15mm

a. atlas to occiput

     i. a_____ a_____ -o_____ m_____

anterior atlanto-occipital membrane (continuation of the ALL)

     ii. p_____ a_____ -o_____ m_____

posterior atlanto-occipital membrane

     iii. a_____ b_____ (of c_____l_____)

ascending band (of cruciate ligament)

b. axis to occiput (via dens)

     i. t_____ m_____

tectorial membrane (continuation of the PLL)

     ii. a_____ l_____

alar ligaments (occipital-alar portion)

     iii. a_____ l_____

apical ligament

c. atlas to axis

     i. t _____l_____

transverse ligament (horizontal part of cruciate)

     ii. a _____ l_____

alar ligaments (atlanto-alar portion)

     iii. d_____ b_____ (of c_____l_____)

descending band (of cruciate ligament)

57. Complete the following:

G6p.718:100mm

a. What structure is the cephalad extension of the

     i. anterior longitudinal ligament?

anterior atlanto-occipital membrane

     ii. posterior longitudinal ligament?

tectorial membrane

b. Which structures are most important in maintaining atlanto-occipital stability?

     i. t_____ m_____

tectorial membrane

     ii. a_____ l_____

alar ligaments

58. Complete the following:

G6p.719:60mm

a. Name the horizontal component of the cruciate ligament.

transverse ligament

b. What does it hold together?

odontoid and atlas

c. What is the strongest ligament in the spine?

transverse ligament

59. Complete the following:

G7 p.952:55mm

a. The best method by which to measure is the_____.

BAI-BDI (basion axial interal-basion dental interval)

b. It is considered normal if each is less than_____ mm.

12

c. Another method is called the_____ _____.

Powers ratio

d. Traction may be used but _____% of patients deteriorate.

10%

60. Complete the following:

G7 p.952:145mm

a. A measurement used in evaluating atlanto-occipital dislocation (AOD) is called_____ _____.

Powers ratio

     i. divide distance from basion to _____ _____ _____ of_____

post prior arch of atlas

     ii. by distance from opisthion to _____ _____ of_____

anterior arch of atlas

b. It is considered normal if below_____.

0.9, > 0.9 and < 1 = gray zone

c. It is definitely abnormal if above_____.

1 = AOD (assumes an intact atlas and foramen magnum)

61. Powers ratio greater than_____ is diagnostic of atlanto-occipital dislocation.

1.0

G7 p.952:145mm

62. AOD is suspected if

G7 p.953:70mm

a. the atlanto-occipital interval is greater than_____ mm and/or

2

b. there is blood in the_____ _____.

basal cisterns

G7 p.954:45mm

63. Complete the following:

G7 p.954:130mm

a. Can they involve the hypoglossal nerve?

yes

b. List the types.

     i. I is a_____ fracture.

comminuted

     ii. II has a_____ fracture.

linear

     iii. III has an_____ fracture.

avulsion

c. Treatment is with_____ or _____.

collar or halo

d. Incidence in trauma patients is_____%.

0.4%

G7 p.955:35mm

64. Answer the following about atlantoaxial dislocation:

G7 p.955:120mm

a. True or False. It has less morbidity and mortality than atlanto-occipital dislocation.

true

b. Name and describe the three types.

     i. rotatory subluxation

     ii. atlanto-axial dislocation

            type I

            transverse ligament_____

intact

            facet capsule_____

bilateral injury

            treatment_____

soft collar

            type II

            transverse ligament_____

injured

            facet capsule_____

unilateral injury

            treatment _____

Philadelphia collar or SOMI

            type III

            transverse ligament _____

injured

            facet capsule_____

bilateral injury

            treatment _____

halo

     iii. anterior atlanto-axial dislocation

            o_____ f_____

odontoid fracture

            c_____ h_____

congenital hypoplasia

            d_____ of t_____ l_____

disruption of transverse ligament

65. Complete the following regarding atlanto-axial rotatory subluxation:

G7 p.956:40mm

a. Name four causes. Hint: stur

     i. s_____

spontaneous

     ii. t_____

trauma

     iii. u_____

upper respiratory tract infection (Grisel syndrome)

     iv. r_____

rheumatoid arthritis

b. Competence of the _____ _____ must be assessed.

transverse ligament

c. What is the characteristic head position?

“cock robin” (20 degrees lateral tilt, 20 degrees rotation opposite, slight flexion)

d. Patients are usually _____.

young

G7 p.956:70mm

e. It can occlude the _____ arteries.

vertebral

66. Complete the following regarding the rule of Spence:

G7 p.957:120mm

a. It is designed to determine if the_____ _____ is disrupted.

transverse ligament

b. If disrupted what effect does it have on treatment?

halo versus collar

c. It is performed by studying what view on x-ray?

open-mouthed AP odontoid view

d. To assess what structures?

lateral masses of C1-C2 overhang

e. The critical reference number is_____.

7 mm—sum of both sides

67. Complete the following:

G7 p.957:165mm

a. isolated fracture _____%

56%

b. combined with C2 fracture _____%

44%

c. additional spine fracture _____%

9%

d. combined with head injury _____%

21%

68. True or False. Regarding a Jefferson fracture:

G7 p. 958:35mm

a. It involves a single fracture through the arch of C1.

false (At least 2 fracture sites—it’s a ring!)

b. It is generally a stable fracture.

false (But without neurologic deficit.)

c. “Rule of Spence” assesses displacement of the dens on a lateral C-spine x-ray.

false (Rule of Spence assesses the lateral movement of the C1 lateral masses; if sum of overhang of both sides > 7 mm, halo will be necessary for treatment; assessed on AP C-spine x-ray.)

d. Treatment is generally surgical (fusion).

false (Treatment is generally with external immobilization—soft collar or rigid external device.)

69. Complete the following about acute fractures of the axis:

G7 p.959:35mm

a. Represent _____% of cervical fractures

20%

b. Neurologic deficit occurs in _____%.

10%

70. Complete the following:

G7 p.960:13mm

a. True or False. Regarding hangman’s fracture:

     i. In contrast to judicial hanging, modern-day hangman’s fractures result from hyperextension and distraction.

false (hyperextension and axial loading)

     ii. This is usually a stable fracture.

true

     iii. There is a common occurrence of nonunion, hence the need for surgery.

false (usually heal with external immobilization)

b. Hangman’s fracture results in a fracture through the _____.

pars interarticularis bilaterally

c. It is also known as _____.

traumatic spondylolisthesis of the axis

71. Complete the following regarding hangman’s fracture:

G7 p.960:58mm

a.

     i. Subluxation of C2 and C3 by more than _____ mm

3

     ii. indicates _____ disruption.

disc

b.

G7 p.961:106mm

     i. This is a marker for _____

instability

     ii. and usually requires _____.

stabilization

72. Classify hangman’s fractures and give the subluxation, angulation, and neurologic deficit.

G7 p.960:70mm

a. Type I

     i. subluxation: _____

< 3 mm

     ii. angulation: _____

0

     iii. neurologic deficit: _____

0

b. Type IA

     i. subluxation: _____

2 to 3 mm

     ii. angulation: _____

0

     iii. neurologic deficit: _____%

33%

c. Type II

     i. subluxation: _____

> 3 mm

     ii. angulation: _____

not specified

G7 p.960:150mm

     iii. neurologic deficit: _____

rare

d. Type IIA

     i. subluxation: _____

< 3 mm

     ii. angulation: _____

> 15 degrees

     iii. neurologic deficit: _____%

10%

e. Type III

     i. subluxation: _____

yes

     ii. angulation: _____

facets locked

     iii. neurologic deficit: _____

deficit: ± fatal: occasionally

f. A special caution for fractures IIA and III it is best to avoid the use of _____.

traction

g. Whose classification is this?

Effendi

73. Describe radiologic abnormalities of hangman’s fractures.

G7 p.960:82mm

a. Type I

     i. vertical pars fracture

yes

     ii. disruption

none

b. Type IA

     i. vertical pars fracture

yes, nonparallel

     ii. disruption

none

c. Type II

     i. vertical pars fracture

yes

     ii. disruption

C2-3 disc

d. Type IIA

     i. vertical pars fracture

yes, oblique

     ii. disruption

none

e. Type III

     i. vertical pars fracture

yes

     ii. disruption

facets of C2/C3 subluxed or locked

74. Classify hangman’s fractures.

G7 p.960::90mm

a. Type I

     i. subluxation less than _____ mm

3 mm

     ii. angulation _____

none

b. Type IA

     i. C2 appearance

elongated

     ii. canal

narrowed

     iii. typical?

atypical

     iv. paralysis?

33%

c. Type II

     i. subluxation more than_____ mm

3 mm

     ii. angulation more than _____

11 degrees (indicates disruption of C2-3 disc and PLL)

d. Type IIA

     i. subluxation is _____

< 3 mm

     ii. angulation _____

more angulation than type II

e. Type III

     i. facets are _____ and

C2-3 facets disrupted (conceptually similar to bilateral jumped facets)

     ii. _____ with traction

nonreducible

75. Most hangman’s fracture patients

G7 p.961:60mm

a. present neurologically _____ and

intact

b. need MRI to assess _____ disc.

C2-C3

c.

G7 p.962:26mm

     i. It can be treated with _____

immobilization

     ii. for _____ weeks.

12

d. Average time to heal is _____ weeks,

11.5

76. Describe treatment of Effendi classification fractures

G7 p.963:110mm

a. Type I: c_____

collar

b. Type IA: c_____

collar

c. Type II: Less than 5 mm sublux and less than 10 degrees angulation

     i. t_____

traction

     ii. h_____

halo

d. Type IIA: More than 5 mm sublux or more than 10 degrees angulation_____

surgical fusion

     i. no t_____

traction

     ii. h_____

halo

e. Type III:

     i. M_____

MRI

     ii. s_____

surgery (ORIF)

77. Describe the radiologic criteria of good fusion.

G7 p.963:110mm

a. Across the fracture site we should see_____.

trabeculations

b. Flexion-extension radiographs should show no _____.

movement

78. Complete the following about odontoid fractures:

G7 p.963:160mm

a. Odontoid fractures represent approximately _____% of all cervical spine fractures.

10 to 15%

b. Mechanism of injury is usually _____.

flexion

c. They are fatal in about _____%.

25 to 40%

d. Major deficits in type II is _____%.

10%