Spine4.odontoid
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An 92 year old male presented to the emergency department after a mechanical fall at a nursing home with neck pain. Imaging showed a type II odontoid fracture. He was placed in a rigid cervical collar and referred to spine surgery for further management which may include halo vest immobilization or surgical fixation.
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An elderly male presented to the emergency department after a mechanical fall at a nursing home with neck pain. Imaging showed a type II odontoid fracture. He was placed in a rigid cervical collar and referred to spine surgery for further management which may include halo vest immobilization or surgical fixation depending on the stability and displacement of the fracture.
Lunate dislocation Power Point
A 65-year-old woman presented to the emergency department with right hand pain after falling down six steps. On examination, she had swelling of the right hand with limited motion of the wrist and hand. She was diagnosed with a lunate dislocation of the right wrist. Treatment involves repositioning the lunate bone, which may require surgery to stabilize. Complications are common if not treated promptly, and recovery takes a minimum of six months.
Pneumomediastinum
1. A 34-year-old man presents with ongoing chest pain following crack cocaine use that morning. He is tachycardic but otherwise stable on exam.
2. Chest x-ray shows pneumomediastinum with thin layers of air outlining the heart borders and along the aorta.
3. Pneumomediastinum is usually benign and self-limiting but can be caused by alveolar rupture from forceful inhalation like with cocaine use. The patient requires monitoring and rest until symptoms resolve.
Barton’s fracture
A 68-year-old female presented after falling and injuring her left wrist while getting out of the shower. On examination, she had obvious swelling and deformity of the right wrist with limited range of motion. X-rays revealed a distal radius fracture with dislocation of the radiocarpal joint, known as a dorsal Barton's fracture. Treatment would involve pain control, closed reduction of the fracture under sedation, and orthopedic consultation as non-operative treatment often fails for this type of injury.
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.
Chance Fracture
A 54-year-old obese male was involved in a single car MVC where his truck struck a tree while restrained only by a lap belt. He reported brief loss of consciousness, low back pain, and abdominal pain and was unable to walk due to pain. On examination, he had severe thoracolumbar midline back pain without deformity and intact neurologic exam. A Chance fracture was suspected due to the mechanism and findings.
Mallet finger
A 27-year-old male baseball player presents with pain and swelling isolated to his right index finger DIP joint after hearing a snap during a pitch. Radiographs show a mallet finger injury with an associated avulsion fracture. The diagnosis is a mallet finger with fracture. Treatment involves splinting the DIP joint in extension for 6-10 weeks, unless the fracture is displaced more than 40% or has volar subluxation, in which case surgery may be needed. Complications can include a swan neck deformity if not treated properly.
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Jefferson Burst Fracture
A 21-year-old male presents to the emergency department with midline cervical pain after falling headfirst into a shallow pool while wrestling with friends. On examination, he has mild midline cervical tenderness without neurological deficits. Radiographs reveal a compression fracture of C1 with splitting of the lateral masses, indicative of an unstable Jefferson fracture from an axial blow to the head. The patient requires cervical spine immobilization, orthopedic consultation, and treatment with a halo or skeletal traction and possible cervical fusion due to the instability of the fracture.
Injuries at occipitocervical junction
1) The document discusses injuries at the occipitocervical junction, including classifications of various injuries such as atlanto-occipital dissociation, transverse ligament injuries, rotatory C1-C2 subluxations, and fractures of the occipital condyle, C1, and C2.
2) Evaluation involves imaging such as CT, which is more sensitive than radiographs, to assess injuries and instability based on measurements. Management depends on the specific injury but may include immobilization in a collar, halo vest, or surgery such as occipitocervical fusion.
3) Occipitocervical fusion techniques are described, including use of rods, cables,
Evaluation of Spinal Injury & Emergency Management
This document provides information on spinal injuries, including:
- Traumatic spinal cord injuries result in 12,000 new cases per year in the US. Most injuries occur in men aged 16-30 from vehicle crashes, falls, or sports.
- Injuries are categorized by location (cervical, thoracic, lumbar), stability (stable or unstable), and neurological status (complete or incomplete paralysis).
- Initial treatment follows ATLS protocols to stabilize the spine and assess airway, breathing, circulation, disability, and exposure. Advanced imaging can further evaluate bone and neurological injuries.
Spinal injury
this power point is for educational purposes in the field of neurosurgery and spine surgery hopping to be useful for you all
Cervical trauma
This document provides an overview of cervical trauma and cervical spine injuries. It discusses anatomy, mechanisms of injury, history and examination findings, imaging, classifications of injuries including fractures and spinal cord syndromes, and indications for surgical intervention. The key points are that cervical spine injury must be considered in polytrauma patients, manual stabilization is needed in addition to collars, and imaging such as CT and MRI can help classify fractures and rule out injuries when clinical suspicion remains.
proximalfemoralfractures-190716152524.pptx
This document discusses the anatomy, classification, treatment, and complications of proximal femoral fractures. It begins by covering the anatomy of the proximal femur and blood supply. It then discusses the AO classification system and Garden classification for femoral neck fractures. Treatment options are presented for different fracture types, including internal fixation and hemiarthroplasty. Complications of various treatments like nonunion and avascular necrosis are also summarized. Studies comparing treatments like screw fixation versus hemiarthroplasty in elderly patients are reviewed.
Pitfalls in orthopaedics
This document discusses orthopaedic emergencies and the evaluation and management of trauma patients. It notes that open fractures and dislocations can threaten limbs and must be addressed immediately. The primary survey focuses on the ABCDEs - Airway, Breathing, Circulation, Disability, and Exposure. Circulation issues like hemorrhage must be controlled through direct pressure, tourniquets, IV fluids and possible blood transfusion. Immobilization is important to stabilize fractures and dislocations while avoiding complications. Antibiotics are often needed for open injuries. Special considerations are discussed for pediatric patients and complications of casting or traction.
Diastasis
A 27-year-old male was brought to the trauma bay after a high-speed motor vehicle collision with significant car damage. He complained of severe abdominal and pelvic pain. On examination, he appeared pale and in discomfort, with tenderness to palpation in the lower abdomen and an unstable pelvis. Initial management included fluid resuscitation, pain control, and stabilizing the pelvis to avoid excessive movement, as pelvic fractures from high-impact injuries can lead to life-threatening hemorrhage.
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.
Noon conf. [Ext.Worawan]
1) A 35-year-old male presented to the emergency department with a right posterior hip dislocation after a motor vehicle accident where his knees hit the dashboard.
2) Physical exam revealed tenderness over the right hip with limited range of motion. X-rays confirmed a posterior dislocation of the right hip.
3) The patient was diagnosed with a posterior right hip dislocation and mild head injury. He underwent closed reduction of the hip dislocation in the operating room followed by skin traction. Post-reduction films showed adequate reduction of the hip.
upper cervical trauma.pptx
- A 62-year-old male presented with severe neck pain after a fall from a ladder one week prior.
- MRI showed a left lateral mass fracture of C1 and a left posterior arch linear fracture of C1.
- The patient was subsequently admitted to the hospital for a liver abscess and left intraocular infection.
- Fractures of the upper cervical spine like those seen in this patient require careful evaluation to determine appropriate treatment, whether conservative management with a collar or surgical stabilization is necessary.
Cervical spine injuries and its management
This document discusses cervical spine injuries, their classification, mechanisms of injury, diagnosis, and management. Some key points:
1. Cervical injuries can be caused by traction, direct impact, or indirect forces like flexion, compression, or rotation. Imaging helps classify injuries and assess stability.
2. Unstable injuries with neurological deficits or multiple injuries may require urgent surgical stabilization. Otherwise, initial treatment focuses on immobilization using rigid collars, braces, halo traction, or halo vests.
3. Common injuries include fractures of C1-C2 and the odontoid process. Type II odontoid fractures are prone to displacement and non-union, so may need open reduction and fusion
cervicalspineinjuriesanditsmanagement-161119063840.pdf
This document discusses cervical spine injuries, their classification, mechanisms of injury, diagnosis, and treatment approaches. Some key points:
1. Cervical injuries can be caused by traction, direct impact, or indirect forces like flexion, compression, or rotation. Imaging helps classify injuries and assess stability.
2. Unstable injuries with neurological deficits or multiple injuries may require urgent surgical stabilization. Otherwise, treatment focuses on immobilization, reduction if needed, and rehabilitation.
3. Common injuries include fractures of C1-C2 and the odontoid process. Treatment depends on fracture type and stability but may involve traction, halo vest immobilization, or anterior/posterior fusion.
Cervical Spine Pain - Dr S L Yadav
Cervical pain is a common musculoskeletal problem. It can be caused by injuries or conditions affecting the cervical spine joints, ligaments, muscles or nerves. Clinical evaluation involves assessing the pain characteristics, neurological examination and diagnostic imaging when needed. The majority of acute cervical pain resolves within weeks with conservative treatment, but some may become chronic. Cervical myelopathy presents with signs of damage to the spinal cord like lower motor neuron signs in the upper limbs and upper motor neuron signs below the level of lesion.
Common fractures svh jmo
This document provides an orthopaedic registrar's overview of common fractures and how to assess and describe them. It covers topics like fracture patterns, x-ray views needed, anatomical location descriptions, and treatments. Examples of common fractures are discussed like wrist, forearm, supracondylar humerus and femoral neck fractures in both children and adults. Complications and classifications like Salter-Harris and Garden are also reviewed. Clinical cases of hip fracture patients are presented at the end.
Pelvic ex fix
This document discusses the use of external fixation for pelvic injuries. It notes that external fixation is commonly used for emergency stabilization of pelvic ring injuries. While it provides adequate stability for some types of injuries, its stability is poor for vertically unstable type C injuries. External fixation is best as a temporary measure in the emergency department or as part of a hybrid fixation approach combined with internal fixation. Placement of screws in the supra-acetabular region is preferred to the iliac crest for better holding power and soft tissue coverage.
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.
Lecture occipital cervical fusion for rheumatoid arthritis
Dr. Smith
Anesthesia: Dr. Jones
Procedure:
The patient was brought to the OR in supine position, prepped and draped in the usual sterile fashion. A midline incision was made from the inion to C7. Subperiosteal dissection was performed down to the occiput and C7. Lateral fluoroscopy was used to identify the appropriate levels. A high-speed burr was used to perform a laminectomy from C1 through C6. Pedicle screws were placed bilaterally at C2, C3, C4, C5, C6 and C7 under fluoroscopic guidance. Occipital screws were placed bilaterally under the superior n
Management of neglected monteggia fracture
presentation contains extensive review of literature regarding management of neglected monteggia and various methods and techniques
Chance Fracture
A 54-year-old obese male was involved in a single car MVC where his truck struck a tree. He was restrained by a lap belt only and reported brief loss of consciousness and low back and abdominal pain, making it difficult to ambulate. On examination, he had severe thoracolumbar back pain without deformity and intact neurologic function. Given his mechanism of injury and symptoms, further imaging was obtained to evaluate for possible Chance fracture and associated intra-abdominal injuries.
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Evaluation of Spinal Injury & Emergency Management
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Lecture occipital cervical fusion for rheumatoid arthritis
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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.
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.
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.
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.
Acetabular fracture Power Point
A 25-year-old male was brought to the emergency room after a head-on motor vehicle collision where the passenger cabin was intruded. He complained of severe right hip pain. On examination, he had a right hip deformity and tenderness. He was given pain management and an orthopedics consult, and was admitted for operative repair of an acetabular fracture.
Mallet Finger Power Point
A 20-year-old male presented with pain in his right index finger after a basketball hit the end of the finger. On examination, the distal interphalangeal (DIP) joint of the right index finger was swollen, tender to touch, and the patient was unable to extend the DIP joint. A diagnosis of an intra-articular avulsion fracture of the dorsal surface of the distal phalanx was made. The treatment plan included pain control, splinting the DIP joint in extension for 6-8 weeks while allowing the other finger joints to move freely, and possible surgery if the fracture involved over 25% of the articular surface.
Bennet's Fracture Power Point
A 30-year-old male presented to the emergency department with right hand pain after punching a brick wall. He has a history of Hepatitis C and heavy alcohol use. On examination, he had tenderness and swelling over the first metacarpal bone. X-rays revealed a Bennett fracture, an intra-articular fracture of the base of the first metacarpal with a triangular fragment. The fracture was treated with closed reduction, thumb traction, and splinting. He was referred to an orthopedist for follow up.
Rolando Fracture Power Point
A 55-year-old male presented to the emergency department with left thumb pain after punching a police officer's bulletproof vest. Upon examination, there was pain and swelling at the base of the first metacarpal bone. The patient was diagnosed with a comminuted intra-articular fracture at the base of the thumb metacarpal bone. Treatment included immobilization, pain control, orthopedic referral, and typically requires operative management.
Boxers fracture Power Point
A 17-year-old male presents with pain and swelling of his right hand after punching a wall out of frustration during an argument with his girlfriend. On examination, he has pain and swelling at the base of his small finger with a bump on the back of his hand. The doctor suspects a boxer's fracture of the small finger metacarpal. Treatment involves splinting the finger, attempting closed reduction by bending the finger joints at 90 degrees, pain control, and orthopedic referral if reduction is unacceptable with over 30-40 degrees of angulation.
Scapholunate dissociation Power Point
A 46-year-old male presented with left wrist pain after falling on an outstretched hand on ice two days prior. Examination revealed pain with wrist rotation and a click sound with certain movements. Imaging showed a scapholunate dissociation, a ligament tear between the scaphoid and lunate bones. Without treatment, this injury can lead to carpal instability and arthritis. The patient was referred to orthopedics for surgical repair.
Scaphoid fracture Power Point
A 15-year-old male presented to the emergency department complaining of right hand pain after falling on an outstretched, dorsiflexed hand. On examination, he had normal vital signs and findings except for pain in the anatomical snuffbox area of the right forearm. Suspecting a scaphoid fracture, the patient's hand was placed in a thumb spica splint, he was prescribed pain medication, and referred to orthopedics. Scaphoid fractures usually cause pain and swelling at the base of the thumb that is worsened with thumb or wrist movement or gripping. Any wrist pain that persists after an injury may indicate a fracture.
Barton’s fracture Power Point
A 68-year-old female slipped in the shower, falling onto her outstretched hand and injuring her left wrist. She was found to have obvious swelling and deformity of the right wrist with limited range of motion. The diagnosis was a distal radius fracture with dislocation of the radiocarpal joint. Treatment would involve pain control, closed reduction of the fracture under sedation, and consultation with orthopedics as non-operative treatment often fails for this type of injury.
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Spine4.odontoid
- 2. Elderly 92 yo male w/ h/o osteopenia presents to ED from nursing home w/ neck pain after a mechanical fall. Pt tripped while trying to walk to restroom. Denies LOC. Pt c/o moderate midline cervical pain upon application of c-collar by EMS on scene. No gross abnormalities appreciated. T 98.9 P 88 BP 325/78 O2 98% RA RR 18 Gen: WDWN, NAD, ccollar in place HEENT: bruising to face, PERRL, EOMI Back: moderate midline cervical tenderness, no bony abnormalities or step offs Neuro: 5/5 strength throughout, pt moves all extremities well
- 4. • Description • oblique avulsion fx of tip of dens caused by an avulsion of alar ligament • alar ligaments connect the dens to the occiput • may be associated with occipitoatlantal dislocation (unstable injury) • Type I fracture is rare © 2000 by the Rector & Visitors of the University of Virginia http://www.med-ed.virginia.edu/courses/rad/cspine
- 5. Stable fracture Maintain C-spine precautions Spine consult cervical collar for symptomatic management
- 7. • Description • most common • occur thru base of odontoid process • Mechanism • hyperflexion or hyperextension • blood supply is often compromised • Radiographs: • prevertebral soft tissue swelling © 2000 by the Rector & Visitors of the University of Virginia http://www.med-ed.virginia.edu/courses/rad/cspine /
- 8. Rigid cervical collar Spine consult Halovest for 3 months if: initial dens displacement is < 5 mm reduction is maintained pt is younger than 50 years of age Surgical fixation
- 9. • Description: • extends into the vertebral body of C2 • Mechanism • hyperflexion or hyperextension • Stability • unstable © 2000 by the Rector & Visitors of the University of Virginia http://www.med-ed.virginia.edu/courses/rad/cspine/
- 10. Rigid cervical collar Spine consult Halovest for 12 weeks vs. surgical fixation
- 11. Open mouth odontoid view is the best view to evaluate for odontoid fracture Evaluate films for alignment of lateral masses and distance of C1 lateral mass to the dens