Odontoid fractures in the elderly
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This document discusses odontoid fractures and their treatment. It provides details on the anatomy of the odontoid process (C2 vertebra) and describes a case of a 69-year-old man who fell and suffered a C2 fracture. It then reviews literature on outcomes of operative versus non-operative treatment of odontoid fractures in older patients, finding that operative patients had longer hospital stays but lower mortality rates. Risk factors for non-union of odontoid fractures are discussed. The document also provides further anatomical details on ligaments surrounding the C1-C2 vertebrae.
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- Many neurological disorders simultaneously or consecutively affect the brain and spinal cord, however most neurologist find their comfort zone in attending the diagnosis via the brain access.
- This concept resulted in lagging of spinal cord imaging researches compared to brain ones and consecutive underestimation of the opportunity of an important tool sometimes essential to reach a definite diagnosis.
1.in order to be the most spinal best.pptx
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Orthopedics 5th year, 4th lecture (Dr. Hamid)
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Spinal injury
this power point is for educational purposes in the field of neurosurgery and spine surgery hopping to be useful for you all
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Fracture and dislocation of the shoulder girdle
The document discusses anatomy, mechanism of injury, classification, diagnosis, and management of anterior shoulder dislocations. Key points include:
- Anterior shoulder dislocations are caused by an anteriorly directed force on the arm when abducted and externally rotated, which can tear the anterior labrum and ligaments.
- Associated injuries may include bone fractures like bony Bankart lesions or Hill-Sachs defects. Labral injuries include Bankart lesions in 80-90% of cases.
- Treatment depends on any associated injuries and classification. Most cases are treated non-operatively with sling immobilization followed by physical therapy. Surgery is required for repair of labral tears or bone defects.
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The document describes the anatomy and common injuries of the elbow joint. It discusses the bones and ligaments that make up the elbow, including the humerus, ulna, radius, and collateral ligaments. Common injuries mentioned include supracondylar fractures in children, lateral condyle fractures, pulled elbow, distal biceps ruptures, triceps tendonitis, triceps ruptures, olecranon impingement, olecranon stress fractures, and olecranon bursitis. Treatment options and potential complications are provided for some of the main injuries.
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Dr. Yashveer Singh presented on primary vertebral body tumors. He discussed the different types of benign primary tumors that can occur including osteochondroma, hemangioma, eosinophilic granuloma, aneurysmal bone cyst, osteoid osteoma, and osteoblastoma. The presentation covered the pathology, clinical features, radiologic evaluation, and management of each tumor type. Pain is usually the primary symptom, and treatment involves surgery, embolization, or other procedures depending on the specific tumor and symptoms.
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Neck injuries from trauma can be life-threatening due to the important structures in the neck. A systematic approach is needed to evaluate and manage neck injuries. It is important to understand the neck anatomy, which can be divided into zones. Zone 1 injuries carry the highest risk and mortality. Common injuries include fractures to laryngeal cartilage and soft tissue injuries. Injuries are evaluated with imaging and laryngoscopy. Management depends on injury severity and may involve airway support, antibiotics, steroids, or surgery to repair damaged structures.
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This document discusses the surgical anatomy and history of surgical sympathectomy. It begins with the anatomy of the sympathetic nervous system and sympathetic trunks. It then discusses the historical approaches to thoracic sympathectomy including open and minimally invasive techniques. The key points are:
- Thoracoscopic sympathectomy has high success rates for treating hyperhidrosis with low complication rates.
- It involves clipping or cutting the sympathetic chain and rami between T2-T3 to denervate the hands. Care must be taken to preserve T1 to avoid Horner's syndrome.
- Compensatory hyperhidrosis is a common complication but most others are rare if T1 is preserved.
Paravertebral Cevical Sympathetic Block
The document discusses paravertebral cervical sympathetic block, including:
- Its history dating back to 1905-1910 with further developments in the 1920s and 1930s.
- Applied anatomy of the sympathetic chain and ganglia in the cervical region, including the stellate ganglion.
- Indications for stellate ganglion block such as CRPS, ischemic diseases, and hyperhidrosis.
- Techniques for the block including the anterior paratracheal approach using local anesthetic.
- Potential side effects include Horner's syndrome and diffusion of the local anesthetic to nearby nerves.
Proximal humerus fractures
Defined as fracture occurring at or proximal to the surgical neck
It is the commonest fracture affecting the shoulder girdle in adults.
Proximal humeral fracture 80% of all humeral fractures.
In pts above the age of 65 years, proximal humeral fractures are the 2nd most frequent upper extremity fractures
ANATOMY -
The proximal humerus is retroverted 35 to 40 degrees relative to the epicondylar axis.
Most common is fall onto outstretched upper extremity from a standing height, in older & osteoporotic woman.
Younger pts present following high energy trauma with significant soft tissue injury.
Less common with excessive shoulder abduction, direct trauma, electric shock and seizures r seizures
Cervical spine fractures muhamma
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Cervical Arthritis, Cervical Spondylotic Myelopathy by Pablo Pazmino MD
This video explains Cervical Stenosis and Cervical Spondylosis/Arthritis. When stenosis begins to affect the spinal cord this is called Cervical Spondylotic Myelopathy. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Cervical Stenosis/Arthritis feel free to look us up online www.beverlyspine.com or www.santamonicaspine.com OR call toll free 1-8SPINECAL-1
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Scaphoid non unions
This document reviews scaphoid fractures, including:
- Anatomy, blood supply, biomechanics and kinematics of the scaphoid bone
- Risk factors, classification, investigations and diagnosis of scaphoid fractures
- Treatment options for both acute scaphoid fractures and scaphoid nonunions including nonoperative treatment, operative fixation, bone grafting techniques and outcomes
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Similar to Odontoid fractures in the elderly (20)
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- 1. Spine Conference Odontoid Fractures October 27, 2020
- 2. Odontoid process Dens Processus epitrophysis C2 vertebra dentata
- 3. 69 year old man with C2 fracture Admitted for CHF and while hospitalized was walking to the bathroom at night and fell on to head lacerating forehead. Staff responded to his calls for help and immediately ordered a cervical CT due to complaints of new neck pain PMH: COPD, CHF, anxiety/dep, liver cirrhosis, cognitive decline, pulmonary HTN, SH: retired lives in group home
- 10. 2017 19 retrospective; 2 dead;40% no sx,
- 11. 25% fusion rate Majority satisfied 40% Asx 68% satisfied No one very dissatsified preop Activity level
- 12. high nonoperative non-union rate 30% Morbidity/mortality of non-union and instability? Nonunion rate increases with age
- 17. NONUNION RISKS: Patient age Displacement: >50% or>4-6mm Angulation: >10 degrees Comminution Delay in treatment (3-7 days) Etiology of Non-unions: Vascular Ligament forces Bone apposition Local distraction
- 20. Retrospective, nonrandomized; >65 years old, 2003-2009 from Univ Wash, TJ, U Kansas 322 patients, 157 non-op, 165 operative, operative were younger (80.4 vs. 83.2 yr, follow-up avg 2y,
- 22. Operative n=165 Non- operative=15 7 ALL Patients Hospital stay 15 days 7 days Feeding tube 18% 5% Death at 30 days 7% 22% 14% Death at last follow up 38% 51% 44% Follow up (years) 2.3 (0-7.2) 1.8 (0-7)
- 24. Separated from the atlas 6th week of gestastion and migrated caudally and fused 15mm long 10mm x 10mm AP/axial
- 26. The tectorial membrane is the thin superior continuation of the posterior longitudinal ligament from the body of the axis. It joins the axis body to the clivus on the anterior half of the foramen magnum, and ascends as high as the spheno-occipital synchondrosis and laterally extends to the hypoglossal canal. The alar ligaments join the lateral margins of the sloping upper posterior margin of the dens of C2 to the lateral margins of the foramen magnum (adjacent to the occipital condyles) and lie on either side of the apical ligament. They may be oblique or vertical and are thickest at the occipital attachment. They are paired ligaments that are very strong and limit axial rotation and contralateral lateral flexion of the head. The cruciate ligament of the atlas (also known as the cruciform ligament) is an important ligamentous complex that holds the posterior dens of C2 in articulation at the median atlantoaxial joint. It lies behind a large synovial bursa (surrounded by loose fibrous capsule) and consists of two bands: longitudinal band: attaches the body of the C2 (axis) to the clivus and foramen magnum in the midline, lying between the apical ligament and tectorial membrane. It is relatively weak and hence does not contribute any significant stability. transverse band (also known as the transverse atlantic ligament): attaches to a small tubercle on the medial cortex of the C1 (atlas) lateral masses on both sides anterior to the tectorial membrane and dura. It passes posterior to the dens, with a small intervening synovial capsule, fixing the dens to the posterior margin of the anterior arch of the atlas. It is the strongest ligament in the whole spine 2 and arguably the most important! Cruciform ligament
- 28. Secondary ossification (ossiculum terminale) appears at apex at ages 3-6 years and fuses at age 12. Synchondrosis fuses at age 6 and remains a line on x-ray until age 11; 30% adults have a physeal scar; fusion process know as subdental synchondrosis
- 30. 2014; Liverpool, UK; patients type 2&3 over 60 years old; 57 patients age 78 (60-92), 42 type 1 and 15 type 3, 3 surgical, 41% halo, 53% hard collar; at 25 weeks 87% type 2 had union or stable fibrous nonunion. 3 year period observed, halo and hard collar patients did the same with 6 deaths (3 each group) none from fx; Stable fibrous non-union is acceptable, close follow up is necessary
- 34. 55 year old woman with central axial neck pain with no radiculopathy; no signs or symptoms of myelopathy. No history of trauma PMH: hypothyroidism in general healthy
- 40. Thanks