Clay Shoveler's Fracture
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A 17-year-old male was involved in a head-on motor vehicle collision at 35-40 mph and presented with cervical neck pain but was ambulatory and alert. Imaging revealed a C6 spinous process fracture, known as a Clay Shoveler's fracture, which is considered stable and results from flexion against contracted neck muscles during deceleration. The patient was placed in a Philadelphia collar and advised to follow-up with orthopedics in 1-2 weeks for non-operative management given the isolated nature of the fracture.
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Peripheral nerve injuries
This document discusses peripheral nerve injuries, including:
- Classification systems for nerve injuries including Seddon and Sunderland classifications.
- Causes of nerve injuries including trauma, radiation, and ischemia.
- Evaluation of patients including history, physical exam, and electrodiagnostic tests.
- Surgical principles for nerve repair including primary repair, nerve grafts, and nerve transfers.
- Post-operative management including splinting and physical therapy.
- Potential complications include failure of repair, neuromas, and infections.
14 thoracolumbar fractures
This document provides an overview of the evaluation and management of thoracolumbar fractures. It discusses the epidemiology, clinical evaluation including neurologic exam, classification of spinal cord injuries, radiographic evaluation, principles of spinal stability, classification of fractures, and treatment approaches for specific fracture types including compression fractures, burst fractures, flexion distraction injuries, and fracture dislocations. Pharmacological treatment and the role of decompression are also outlined.
Teleconferences 22.2.18
A 36-year-old Thai man presented to the hospital after a motorcycle accident where he collided with a dog and fell off his bike 3 hours prior. He complains of left shoulder and chest pain. Imaging shows a closed fracture of the mid-shaft left clavicle with a left scapula neck fracture. The patient is admitted and managed conservatively with sling immobilization.
Spinal injuries monday 3 10 20014
This document discusses spinal injuries, providing information on important structures of the cervical spine, types of spinal injuries, mechanisms of injury, classifications of stability, diagnosis, and imaging. It notes that the cervical spine is most prone to injury but these can also be devastating, damaging both the vertebral column and neural tissue. Diagnosis involves careful examination and imaging like x-rays, CT scan, and MRI to identify fractures and lesions. Stable injuries will not displace with movement while unstable injuries risk further displacement.
Brachial Plexus injuries (2).pptx
The brachial plexus is formed by the ventral rami of cervical and thoracic spinal nerves C5-T1. It is vulnerable to injury from trauma such as motor vehicle accidents, falls, or excessive traction during childbirth. Injuries are classified based on the location and roots involved. Evaluation involves neurological and sensory exams along with imaging like MRI. Management may include physiotherapy, splinting, nerve grafts or transfers to restore function. The goals are restoration of elbow flexion, shoulder abduction, and medial forearm sensation. Surgical options depend on if the injury is open or closed.
Ext conference ธนวัฒน์
A 62-year-old Thai woman presented to the emergency department after fainting and hitting her head 30 minutes prior. She reported being hit on the right side of her head by her husband which caused her to lose consciousness and fall, injuring her right elbow. On examination, she had deformity and tenderness of the right elbow with limited range of motion due to pain. X-rays revealed a lateral dislocation of the right elbow. The elbow was closed reduced and placed in a splint in flexion for follow up.
Spine injury -halim.pptx
The document discusses injuries to the spine. It covers the epidemiology, anatomy, classification of injuries as stable or unstable, and mechanisms of injury. It then describes specific cervical and thoracolumbar spine injuries, including fractures, dislocations, and treatment approaches which may involve immobilization, traction, or surgery.
Approach to problem fractures
This document discusses fractures that require special attention due to their location or potential to be overlooked. It identifies two main groups - fractures of the ribs, scapula, Lisfranc joint, cervicothoracic junction, and posterior spinal elements, and fractures of the scaphoid, radial head, and femoral neck. It emphasizes the importance of optimal imaging like CT scans to detect these fractures, and provides guidance on imaging techniques and views needed to properly evaluate common fracture sites.
Anterior Hip Dislocation
A 28-year-old male presented with hip pain after falling from a two story building while trying to impress his friends. On examination, his right leg was externally rotated and shortened. This suggests an anterior hip dislocation which needs to be reduced within 8 hours of injury. The patient will need to be immobilized for pain control and to prevent further dislocation. Hip dislocations can lead to fractures of the femoral head or neck.
Day 2 | CME- Trauma Symposium | Master trauma panel perspective
This document provides guidelines for clearing the cervical spine in trauma patients. It discusses the Canadian C-Spine Rules and Nexus Low Risk Criteria clinical decision rules that can be used to determine if imaging is needed. It also provides algorithms outlining the imaging and precautions recommended based on factors like the patient's age, clinical exam findings, mechanism of injury, and ability to be assessed. The key points are that clinical decision rules can help determine if imaging is needed, and imaging and precautions depend on the results and presence of injuries or neurological abnormalities found.
C5 C6 dislocation
This document summarizes the medical history, physical examination, investigations, diagnosis, and treatment for a 43-year-old male who presented with neck pain and weakness in his extremities after a motor vehicle accident. Physical examination revealed neck tenderness and decreased sensation below C6. Imaging showed a C5-C6 unilateral facet dislocation with complete spinal cord injury. The patient received high-dose steroids and was placed in skull traction. He was diagnosed with an incomplete spinal cord injury and underwent operative treatment including closed reduction and stabilization.
thoracolumbar spinal trauma
This document discusses the management of thoracolumbar spine injuries. It begins by outlining common causes of injury and why the thoracolumbar junction is susceptible. It then covers fracture classification systems including Denis' three column concept and the AO/Magerl classification. Evaluation and management approaches are discussed including non-operative treatment with bracing and operative options depending on fracture pattern and neurological status. Surgical techniques like posterior instrumentation with or without decompression or combined anterior-posterior procedures are mentioned.
Brachial plexus injury diagnosis
This document discusses the anatomy, clinical evaluation, and management of brachial plexus injuries. It begins with the anatomical components of the brachial plexus including roots, trunks, divisions, cords, and branches. It then covers the clinical evaluation including history, physical exam findings, and investigations like imaging and electrodiagnostic studies. Key aspects of the physical exam are described for assessing specific nerves and muscles. The document concludes with classifications of brachial plexus injuries and considerations for non-operative versus operative management.
Spinal Injuries
The document provides information on spinal cord and cervical spine anatomy, mechanisms of spinal cord injury, clinical assessment of spinal cord injury patients, imaging for spinal cord injuries, classification of spinal cord injuries, and management principles for spinal cord injuries. Key points covered include the incidence of spinal cord injuries, common mechanisms and levels of injury, assessment of motor and sensory function, classification systems for incomplete versus complete injuries, and guidelines for cervical spine clearance in trauma patients.
cranio-vertebralanomalies-overview-copy-151214131323 (1).pptx
The document discusses the anatomy, classification, and imaging of cervical vertebral anomalies. It describes the following key points:
1. The cervical vertebrae have complex articulations and ligaments that allow flexion, extension, and rotation. Common anomalies involve bony fusions or ligamentous laxity.
2. Anomalies are classified as congenital bony anomalies, soft tissue anomalies like Chiari malformation, or developmental/acquired issues. Atlantoaxial instability and basilar invagination are frequently discussed anomalies.
3. Imaging plays an important role in evaluation. Measurements like Chamberlain's line and Atlanto-dens interval on radiographs help characterize anomalies and risk of cord compression.
Proximal humerus fractures
- Humeral fractures are common, especially in older adults, with the surgical neck being the most common site. Most fractures are nondisplaced and can be treated nonsurgically.
- Displaced fractures, fractures with rotator cuff injuries, and those in poor bone quality patients may require surgical treatment like open reduction and internal fixation using plates or pins.
- Complications can include malunion, nonunion, avascular necrosis, and arthritis, so careful follow up is needed after surgical treatment of humeral fractures.
The elbow fracture
The document discusses the anatomy and common injuries of the elbow joint. It begins with the bones and ligaments that form the elbow joint. It then describes the muscles that flex, extend, supinate, and pronate the elbow. Common fractures discussed include fractures of the medial epicondyle, lateral epicondyle, radial head, coronoid process, olecranon, and elbow dislocations. Treatment options like splinting, open reduction internal fixation, and elbow replacement are covered. Pulled elbow, or subluxation of the radial head in children, is also summarized.
Similar to Clay Shoveler's Fracture (20)
Spinal Trauma: The Legend of the C-Spine Collar - A Case Report
Spinal Trauma: The Legend of the C-Spine Collar - A Case Report
Evaluation of Spinal Injury & Emergency Management
Evaluation of Spinal Injury & Emergency Management
Day 2 | CME- Trauma Symposium | Master trauma panel perspective
Day 2 | CME- Trauma Symposium | Master trauma panel perspective
cranio-vertebralanomalies-overview-copy-151214131323 (1).pptx
cranio-vertebralanomalies-overview-copy-151214131323 (1).pptx
More from Todd Peterson
Pneumothorax Power Point
A 34-year-old man presents with 2 days of right-sided chest pain that worsens with deep breathing and radiates to his neck and shoulderblade. He has a history of tobacco use but no other medical problems. Examination finds him in no distress. Chest x-ray shows a right-sided pneumothorax. Treatment depends on size and symptoms, with small primary pneumothoraces sometimes observed as outpatients and larger or recurrent ones requiring chest tube placement in the hospital. Pneumothoraces are classified as primary spontaneous, secondary spontaneous, or traumatic based on associated lung disease or injury history.
Pneumomediastinum
A 34-year-old man presents with sharp chest pain for 2 hours following crack cocaine use. He has no other symptoms. On examination, he has a heart rate of 148, blood pressure of 98.7/105, respiratory rate of 18, and clear lungs. Chest x-ray shows pneumomediastinum. The patient is admitted for observation and treatment with oxygen and IV fluids.
Aortic dissection
A 56-year-old man presents with 4 hours of epigastric abdominal pain described as sharp and stabbing. He has a history of hypertension and coronary artery disease. On examination, he is tachycardic with cool extremities. Imaging shows an enlarged aorta, particularly for his age, which should prompt consideration of an aortic disorder as the cause of his pain. He requires aggressive blood pressure control and emergent surgical consultation given concern for aortic dissection.
Aortic dissection
A 56-year-old man presents with 4 hours of epigastric abdominal pain described as sharp and stabbing. He has a history of hypertension and coronary artery disease. On examination, he is tachycardic with cool extremities. Imaging shows an enlarged aorta, particularly for his age, which should prompt consideration of an aortic disorder as the cause of his pain. He requires aggressive blood pressure control and emergent surgical consultation given concern for aortic dissection.
Lung cancer Power Point
A 69-year-old woman presents with a 3-month history of dry cough, chest pain, weight loss, and exercise intolerance. She has a history of smoking and lung issues. Examination finds her thin but stable. Chest x-ray shows a visible mass in her right upper lung. She may need biopsy or admission depending on stability and ability to follow up as an outpatient. The presentation of lung cancer can vary but often includes nonspecific symptoms. Different types have characteristics like location and growth patterns visible on x-ray.
Pleural effusion Power Point
A 65-year-old man with a history of diabetes, hypertension, coronary artery disease, and end-stage renal disease presented with a 3-day history of dry cough and worsening shortness of breath with exertion. On examination, he had bilateral basilar rales and chest x-ray showed bilateral pleural effusions. He was admitted for supportive respiratory therapy and treatment of the underlying pleural effusions through thoracentesis or tube thoracostomy.
Tuberculosis Power Point
A 34-year-old homeless white male presented with a 5-6 week history of intermittent fever, cough producing blood-tinged sputum, and right-sided chest pain with deep breathing. Examination found decreased breath sounds in the right upper lung field. A chest x-ray showed a cavitary lesion in the right upper lobe and hilar adenopathy, suggestive of tuberculosis. The patient was discharged with instructions for close follow-up and definitive treatment, as admission was not required due to clinical stability and ability to follow-up.
Atypical pneumonia Power Point
A 67-year-old man with diabetes and hypertension presented with worsening fever, malaise, dyspnea, and abdominal pain over two days. On examination, he had a fever, rapid heart rate, diffuse lung rhonchi, and normal abdomen. A chest X-ray showed patchy infiltrates and peri-hilar prominence. Given his atypical presentation and chest X-ray findings, he was started on a macrolide or respiratory fluoroquinolone antibiotic for suspected atypical pneumonia.
Lobar pneumonia Power Point
A 76-year-old female presented with worsening dyspnea, cough producing yellow sputum, subjective fevers and chills, weakness and decreased appetite. Her vital signs and physical exam showed signs of infection. Chest x-rays revealed consolidation in the right middle lobe, suggesting lobar pneumonia. She was treated with oxygen, IV fluids, antibiotics and admitted to the hospital based on her condition.
Pulmonary Embolism Power Point
A 58-year-old female presented to the emergency room with anxiety and shortness of breath after climbing stairs. She has been feeling stressed due to social stressors and recently took a trip to Italy. On examination, she was tachycardic but her lungs were clear to auscultation. A chest x-ray showed blunted costophrenic sulci and opacity of the left lung bases indicating increased blood flow to the left lung. The patient was given oxygen and intravenous fluids, and anticoagulation therapy was started given her risk for pulmonary embolism.
Salter harris 2 Power Point
A 10-year-old boy presented with an obvious deformity to his right wrist following a football injury. X-rays showed a Salter Harris Type II fracture extending from the growth plate through the bone with part of the bone broken off. The boy's wrist was splinted and he was referred to orthopedics for follow-up.
Pitcher's Elbow Power Point
A 10-year-old male pitcher presents with right arm pain after pitching in a little league baseball game. On examination, he is rubbing his right elbow and has tenderness over the medial epicondyle. X-rays are normal but this is likely a case of pitcher's elbow or medial apophysitis from overuse. The parents and patient are instructed that the child must cease pitching for 4-6 weeks and gradually return to avoid further injury.
SCIWORA Power Point
A 3 year old boy presented with new onset lower extremity weakness after falling from a high chair two days prior. On examination, he had decreased strength and sensation in both lower extremities. Cervical spine films and CT were normal. He received a diagnosis of SCIWORA (spinal cord injury without radiographic abnormality) and was admitted for MRI and further evaluation by neurosurgery.
Salter harris 4 Power Point
An 11-year-old male presented to the emergency department after being kicked by a cow, unable to bear weight on his right leg and experiencing excruciating pain. Examination revealed swelling and bruising around the right ankle with pain on movement. X-rays showed a fracture extending from the metaphysis through the epiphysis, classified as a Salter-Harris Type IV injury. This type of injury crosses the physis and involves both the epiphysis and metaphysis, is associated with a worse prognosis than other types, and may affect growth even with perfect reduction. Orthopedic consultation was recommended for possible open reduction and internal fixation if any displacement was present.
Salter harris 1 Power Point
A 9 year old female presented to the emergency department after falling from a horse at summer camp and injuring her right wrist. She complained of pain with palpation and movement of the wrist. Examination revealed mild swelling and tenderness over the wrist, but plain films did not show any obvious abnormalities. Due to the possibility of a Salter Harris I fracture that may not be visible on initial x-rays, the patient was splinted and advised to follow up with orthopedics in 7-10 days for repeat films to check for any delayed findings.
SCFE Power Point
An 11-year-old boy presented with left hip and knee pain for over a week. On examination, he had pain with internal rotation of the left hip. The document emphasizes that slipped capital femoral epiphysis (SCFE) can present as knee pain referred from the hip, so knee complaints should prompt evaluation of the hip. Failure to diagnose SCFE can lead to avascular necrosis, so orthopedic consultation is considered emergent and SCFE is ultimately treated with surgical repair.
Pubic Diastasis Power Point
A 27-year-old male was brought to the trauma bay after a high-speed motor vehicle collision and is complaining of severe abdominal and pelvic pain. On examination, he appears pale and uncomfortable with tenderness to palpation in the lower abdomen and instability of the pelvis. Treatment should include fluid resuscitation, pain control, stabilizing the unstable pelvis to avoid movement, and evaluating for other injuries, as pelvic fractures from high-impact accidents can cause life-threatening hemorrhage or urethral injuries.
Legg calve perthes Power Point
A 7-year-old boy presented with several weeks of left hip and knee pain. On physical exam, he had decreased range of motion of the left hip, especially with internal rotation and abduction. He was diagnosed with Legg-Calve-Perthes disease, which is caused by interruption of blood flow to the capital femoral epiphysis, resulting in bone infarction and fractures. Differential diagnoses included sickle cell disease and septic hip. NSAIDs were prescribed for pain control and orthopedic follow-up was recommended.
Femoral neck fracture Power Point
A 78-year-old woman presented to the emergency department after falling at home and landing on her left hip. On examination, her left hip was tender to touch, her left leg appeared externally rotated and shortened. She was diagnosed with a left femoral neck fracture based on her mechanism of injury and physical exam findings.
Femoral neck fracture
A 78-year-old woman presented to the emergency department after falling at home and landing on her left hip. On examination, her left hip was tender to touch, her left leg appeared externally rotated and shortened. She was diagnosed with a left femoral neck fracture based on her mechanism of injury and physical exam findings.
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Clay Shoveler's Fracture
- 2. 17 yo male restrained driver presents packaged by EMS, involved in car vs tree, head-on MVC at approx 35-40 mph. No LOC, no airbag deployment, broken windshield. Pt did ambulate on scene. C/o cervical neck pain. AFVSS Gen: WDWN, A&Ox4 HEENT: NC/AT, PERRL, TMs intact Neck: C6-C7 CMT without step-offs, trachea midline. Neuro: CNs 2-12 intact, Nml 5/5 motor strength and sensation x 4. Nml reflexes. MSK: No thoracic/lumbar TTP/step-offs. No gross signs of trauma. Long bones and joints palpated without tenderness or instability.
- 4. C6 spinous process fracture. No facet or laminar fracture seen
- 5. Lateral C-spine radiograph, or CT Analgesics Philadelphia C-collar on discharge to be worn for at least 10 days Early follow-up with Orthopedics, 1-2 weeks Non-operative management if fracture is isolated and presence of instability has been ruled out
- 6. Clay Shoveler’s Fracture is considered stable Caused by intense flexion against a contracted posterior erector spinal muscle; MC due to deceleration MVCs Most common at C7 > C6> T1 If avulsion frx is not limited to spinous process but extends into lamina, there is greater potential for spinal cord injury
- 8. Illustration of Clay Shoveler’s Fx and normal vertebral anatomy
- 9. Schwartz DT: Emergency Radiology: Case Studies: http://www.accessemergencymedicine.com Simon RR, Sherman SC: Emergency Orthopedics, 6th ed. Chapter 9: Cervical Spine Trauma. www.accessemergencymedicine.com Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7th ed. Chapter 255: Spine and Spinal Cord Trauma http://radiopaedia.org/cases/barbell-injury-tocervical-spine-c6-clay-shoveler-fracture-1