Fractures of the spine are less common in children than adults but have important differences. Anatomical differences like unfused growth plates make children more prone to fractures in the upper cervical spine. Injuries can occur without radiographic abnormalities due to the spine's increased mobility compared to the spinal cord. Evaluation involves a low threshold for advanced imaging like CT or MRI due to difficulties visualizing cartilage. Treatment focuses on immobilization which is generally well-tolerated in children. Special considerations exist for fractures in the cervical, thoracic, and lumbar regions.
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow FracturesSean M. Fox
Dr. Haley Dusek is an Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. Dr. Ainsley Bloomer is an Orthopedic resident at Carolinas Medical Center. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
•Lateral condyle
•Medial epicondyle
•Monteggia
•Posterior dislocation
•Transphyseal separation
Pediatric cervical spine clearance: A review and understanding of the conceptsApollo Hospitals
Cervical spine injuries are uncommon in pediatric trauma
patients. Delayed or missed diagnosis is usually attributed to failure to suspect an injury to the cervical spine, or to inadequate cervical spine radiology and incorrect interpretation of radiographs. New imaging techniques have become available, but did not solve the problem, adding their own ‘baggage’, such as cost, availability, logistic difficulties, radiation dosage, lack of specificity and evidence of effectiveness or safety.
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow FracturesSean M. Fox
Dr. Haley Dusek is an Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. Dr. Ainsley Bloomer is an Orthopedic resident at Carolinas Medical Center. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
•Lateral condyle
•Medial epicondyle
•Monteggia
•Posterior dislocation
•Transphyseal separation
Pediatric cervical spine clearance: A review and understanding of the conceptsApollo Hospitals
Cervical spine injuries are uncommon in pediatric trauma
patients. Delayed or missed diagnosis is usually attributed to failure to suspect an injury to the cervical spine, or to inadequate cervical spine radiology and incorrect interpretation of radiographs. New imaging techniques have become available, but did not solve the problem, adding their own ‘baggage’, such as cost, availability, logistic difficulties, radiation dosage, lack of specificity and evidence of effectiveness or safety.
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: January CasesSean M. Fox
Dr. Kelsey Lena is Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Clavicle Fractures
Prehospital Care of the Pediatric Trauma Patient dpark419
An evidence based review of prehospital care of the pediatric trauma patient. This lecture was given to EMS personnel at the Medical University of South Carolina on 12/3/14.
Cervical spine clearance lecture given to 1st-year emergency medicine residents at Duke University. Covers indications for applying cervical collar, types of collars, types of imaging of the spine, and when to remove the collar.
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: April CasesSean M. Fox
Dr. Kelsey Lena is Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Tibial Fractures
- Toddler’s Fracture
- Salter-Harris Fractures
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: January CasesSean M. Fox
Dr. Kelsey Lena is Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Clavicle Fractures
Prehospital Care of the Pediatric Trauma Patient dpark419
An evidence based review of prehospital care of the pediatric trauma patient. This lecture was given to EMS personnel at the Medical University of South Carolina on 12/3/14.
Cervical spine clearance lecture given to 1st-year emergency medicine residents at Duke University. Covers indications for applying cervical collar, types of collars, types of imaging of the spine, and when to remove the collar.
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: April CasesSean M. Fox
Dr. Kelsey Lena is Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Tibial Fractures
- Toddler’s Fracture
- Salter-Harris Fractures
Similar to the Pediatric Spine fractures lecture.ppt (20)
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
1. Fractures of the Spine in Children
Timothy Moore, MD
Original Author: Steven Frick, MD; March 2004
Revised:
Steven Frick, MD; August 2006
Timoth Moore, MD; November 2011
2. Important Pediatric Differences
• Anatomical differences
• Radiologic differences
• Increased elasticity
• Periosteal tube fractures – apparent
dislocations
• Surgery rarely indicated
• Immobilization well tolerated
3. Cervical Spine Injuries
• Rare in children - < 1% of children’s fractures
• Quoted rates of neurologic injury in children’s C
spine injuries vary from “rare” to 44% in large
series
• Age less than 7
– Majority of C spine injuries are upper cervical, esp.
craniocervical junction
• Age greater than 7
– Lower C spine injuries predominate
Jones. Pediatric cervical spine trauma. J Am Acad Orthop Surg. 2011;19:600.
5. Multiple Small Diameter Pin Child’s
Halo for Displaced C2 Fracture
Note bolster behind neck
to maintain lordosis and
reduce angulation
6. Multiple Small Diameter Pin Child’s
Halo for Displaced C2 Fracture
Note bolster behind neck
to maintain lordosis and
reduce angulation
Occ-C1 articulation
very axially oriented
7. Anatomy – C1
• 3 ossification centers
at birth – body and 2
neurocentral arches
• Neurocentral
synchondroses (F)
fuse at about 7 years
of age
Copley. Cervical spine disorders in infants and children. J Am Acad Orthop Surg. 1998;6:204.
8. Anatomy – C2
• 4 ossification centers at
birth – body, 2 neural
arches, dens
• Neurocentral
synchondroses (F) fuse at
age 3-6 years
• Synchondrosis between
body and dens (L) fuses
age 3 – 6 years
• Thus no physis /
synchondrosis should be
visible on open mouth
odontoid view in child
older than 6 years
Copley. Cervical spine disorders in infants and children. J Am Acad Orthop Surg. 1998;6:204.
9. Anatomy – C2
• Summit ossification
center (H) appears at
age 3 – 6 and fuses
around age 12
• Do not confuse with
os odontoideum
• Creates confusion with
studies
Copley. Cervical spine disorders in infants and children. J Am Acad Orthop Surg. 1998;6:204.
10. Os Odontoideum
• Thought to be
sequelae of prior
trauma
• May result in C1-C2
instability
• Usually asymptomatic
• Debate about
participation in contact
sports
Fielding. Os odontoideum. J Bone Joint Surg Am 1980;62:376.
12. Anatomy – Lower Cervical
Vertebrae C3 – C7
• Neurocentral
synchondroses (F)
fuse at age 3-6 years
• Ossified vertebral
bodies wedge shaped
until square at about
age 7
• Superior and inferior
cartilage endplates
firmly attached to disc
Copley. Cervical spine disorders in infants and children. J Am Acad Orthop Surg. 1998;6:204.
13. Mechanism of Injury
• Child’s neck very mobile – ligamentous
laxity and shallow angle of facet joints
• Relatively larger head
• In younger patients this combination leads
to upper cervical injuries
• Falls and motor vehicle accidents most
common cause in younger children
14. Cervical Spine Injuries from Birth
Trauma
• Can occur
• May have associated
spinal cord or brachial
plexus injury
• Upper cervical injuries
may be a cause of
perinatal death
Newborn with C5/6 fracture
dislocation
15. Typical Fracture Pattern
• Fractures tend to occur within the endplate
between the cartilaginous endplate and the
vertebral body
• Clinically and experimentally fractures
occur by splitting the endplate between the
columnar growth cartilage and the calcified
cartilage
• Does not typically occur by fracture through
the endplate – disc junction
Jones. Pediatric cervical spine trauma. J Am Acad Orthop Surg. 2011;19:600.
16. C Spine Immobilization
for Transport in Children
• Large head will cause
increased flexion of C
spine on standard
backboard
• Bump beneath upper T
spine or cutout in
board for head to
transport child with
spine in neutral
alignment
17. C Spine Radiographic Evaluation in
Children
• Be aware of normal
ossification centers and
physes
• C2/3 pseudosubluxation
common in children
younger than 8, check
spinolaminar line of
Swischuk
• Evaluation of soft tissues
anterior to spine may be
unreliable in the crying
child -Eubanks. Clearing the pediatric cervical spine following injury.
J Am Acad Orthop Surg 2006;14:552.
-Shaw. Pseudosubluxation of C2 on C3 in polytraumatized
children: Prevalence and significance. Clin Radiol 1999;54: 377.
18. C2-3 Pseudosubluxation
• Listhesis of C2 on 3
• Look for significant
prevertebral soft tissue
• Uncommon injury – usually
occiput to body of C2
Shaw. Pseudosubluxation of C2 on C3 in polytraumatized
children: Prevalence and significance. Clin Radiol 1999;54:
19. C Spine Evaluation in Children
• Mechanism of injury is extremely important
• Physical exam – tenderness (age, distracting
injuries), neurological exam
• Xrays not commonly used
• CT scan to define bony detail
• Low threshold to obtain MRI with stir
sequences
Anderson. Cervical spine clearance after trauma in
children. J Neurosurg. 2006;105(5 Suppl):361–364.
21. Traumatic Spinal Cord Injury
• Rare in children
• Better prognosis for recovery than adults
• Treat aggressively with immobilization +/-
decompression
• Late sequelae = paralytic scoliosis (almost
all quadriplegic children if injured at less
than 10 years of age)
Parent. Spinal cord injury in the pediatric population: a systematic
review of the literature. J. Neurotrauma. 2011;28:1515.
22. Spinal Cord Injury without Radiographic
Abnormality (SCIWORA)
• Cervical spine is more
flexible than the spinal
cord in children
• Can have traction injury to
spinal cord in a child with
normal radiographs
• Usually occurs in upper C
spine, in children younger
than 8
• MRI can diagnose injury
to spinal cord and
typically posterior soft
tissues
Occiput –C1 SCIWORA
Parent. Spinal cord injury in the pediatric population: a systematic
review of the literature. J. Neurotrauma. 2011;28:1515.
23. SCIWORA
• Spinal cord injury without radiographic
abnormality
– Plain x-rays, not MRI
• Distraction mechanism of injury
• Spinal cord least elastic structure
• Young children less than 8 yrs
• Be aware in patient with GCS 3 and normal CT head there
may be upper cervical spinal cord injury!
25. Imaging
• 3 view plain film series still used
• Low threshold for further imaging
• CT scan upper C-spine (O-C2)
• Consider MRI if intubated or obtunded
Sharma. Assessment for additional spinal trauma in
patients with cervical spine injury. Am Surg. 2007;73:70.
26. Not “Cleared” by Plain Films
• CT scan
– Much of peds c-spine
cartilaginous
• Advantages
– Fast
– No sedation or
anesthesia
• Assess alignment
Sharma. Assessment for additional spinal trauma in
patients with cervical spine injury. Am Surg. 2007;73:70.
27. Not “Cleared”
• MRI scan – currently favored
• Rapid sequence/image
acquisition algorithms – gradient
echo
• Evaluate non osseous tissues and
spinal cord
• MRI scan should be considered
in critically injured child for
whom adequate plain films
cannot be obtained to rule out
spinal injury
Sharma. Assessment for additional spinal trauma in
patients with cervical spine injury. Am Surg. 2007;73:70.
28. If not “Cleared” within 12 Hours
• Switch to pediatric Aspen or Miami J collar
• Consider CT or MRI
McCall. Cervical spine trauma in children: a review. Neurosurg Focus. 2006;20(2):E5.
29. Child in C-spine collar
Meets NEXUS criteria:
1. Absence of midline cervical tenderness
2. No evidence of intoxication
3. Normal level of alertness
4. Normal neurological exam
5. Absence of a painful, distracting injury
C-SPINE
CLEAR
YES
Trauma evaluation and
Cervical spine radiographs:
AP/lateral/odontoid for age > 5 yr
AP/lateral only for age ≤ 5 yr
ABNORMAL
RADIOGRAPH
S
Spine Service
Consult
YES
Communicative child
≥ 3 years
Spine Service
Consult
NO
NO
NORMAL
Normal neurological exam
Spine Service
Consult
NO
YES
Flexion/Extension
C-spine x-rays
Spine Service
Consult
ABNORMAL C-SPINE
CLEAR
NORMAL
Leave in collar; refer to neurosurgery
clinic in 1-2 weeks
INADEQUATE
Anderson. Cervical spine clearance after trauma
in children. J Neurosurg. 2006;105(5 Suppl):361.
Clearance Protocol
30. If You See a Spine Fracture
in a Child
• Look hard for another one
• “The most commonly missed spinal fracture
is the second one”. -J. Dormans
• High incidence of noncontiguous spine
fractures in children
Firth. Pediatric Non-Contiguous Spinal Injuries: The 15 year Experience
at One Pediatric Trauma Centre. Spine. 2011 Nov. 14 (Ahead of Print)
31. Multiple Small Diameter Pin Child’s
Halo Occiput to C2 Injuries
Note bolster behind neck
to maintain lordosis and
reduce angulation
32. Thoracic Spine Fractures
• Less common spinal fracture in children
than in more mobile regions
• Rib cage offers some support / protection
• Motor vehicle crashes, falls from heights
• Child abuse in very young
• Compression fractures in severely
osteopenic conditions (OI, chemotherapy)
Slotkin. Thoracolumbar spinal trauma in children. Neurosurg. Clin. N. Am. 2007;18:621.
34. Thoracic Spine Fracture Dislocations
• High energy mechanisms
• Often spinal cord injury, can be transected
• Prognosis for recovery most dependent on
initial exam – complete deficits unlikely to
have recovery
• Infarction of cord (artery of Adamkiewicz)
may play some role –especially in delayed
paraplegia
Slotkin. Thoracolumbar spinal trauma in children. Neurosurg. Clin. N. Am. 2007;18:621.
35. Thoracolumbar Junction Injuries
T11-L2
• Classically lap-belt flexion-distraction
injuries
• Chance fractures and variants
• High association with intraabdominal injury
(50-90%)
• Neurologic injury infrequent but can occur
Arkader. Pediatric chance fractures: a multicenter
perspective. J Pediatr Orthop. 2011;31:741.
36. Chance Fractures and Variants
• Flexion over fulcrum
• Posterior elements fail in tension, anterior
elements in compression
– Can occur through bone, soft tissue or combination
• Treatment
– Pure bony injuries can be treated with immobilization
in extension
– Partial or whole ligamentous injuries may be best
treated with surgical stabilization
Arkader. Pediatric chance fractures: a multicenter
perspective. J Pediatr Orthop. 2011;31:741.
38. Lap Belt Sign
• High association with
intraabdominal injury
and lumbar spine
fracture
• Lumbar spine films
mandatory
Arkader. Pediatric chance fractures: a multicenter
perspective. J Pediatr Orthop. 2011;31:741.
39. 4 yo Lap Belt Restrained Passenger
Intraabdominal Injuries, Paraplegic
40. 2 Year Old with Old L2-3 Fracture
Dislocation from NAT
41. Lumbar Spine Fractures
L3-L5
• Infrequent until late adolescence
– Can be associated with lap belt injuries
• Usually compression fractures that are stable
injuries
• Burst fractures
– May progress to kyphosis
• Lumbar apophyseal injuries
– Posterior displacement can cause stenosis, may need
surgical excision
Slotkin. Thoracolumbar spinal trauma in children. Neurosurg. Clin. N. Am. 2007;18:621.
43. Lumbar Apophyseal Injuries
Slipped Apophysis
• Compression-shear injuries
• Same age group as SCFE
• Typically adolescent males, inferior
endplates of L4 or L5
• Traumatic displacement of vertebral ring
apophysis and disc into spinal canal
• If causes significant compression of cauda
equina, treatment is surgical excision
Chang. Clinical significance of ring apophysis fracture in
adolescent lumbar disc herniation. Spine. 2008;33:1750.
44. 3 Types of
Slipping of Vertebral Apophysis
Tarr. MR imaging of recent spinal trauma. J Comput Assist Tomogr. 1987;11:412.
45. Burst Fractures
• Usually in older adolescents
• Treatment similar to adults
• May not need surgery in neurologically
intact patient
• Injuries at thoracolumbar junction higher
risk for progressive kyphosis
Slotkin. Thoracolumbar spinal trauma in children. Neurosurg. Clin. N. Am. 2007;18:621.
46. Bibliography
• Anderson RCE, Scaife ER, Fenton SJ, Kan P, Hansen KW, Brockmeyer DL. Cervical spine clearance after trauma
in children. J Neurosurg. 2006 Nov.;105(5 Suppl):361–364.
• Arkader A, Warner WC, Tolo VT, Sponseller PD, Skaggs DL. Pediatric chance fractures: a multicenter perspective.
J Pediatr Orthop. 2011 Sep.;31(7):741–744.
• Chang C-H, Lee Z-L, Chen W-J, Tan C-F, Chen L-H. Clinical significance of ring apophysis fracture in adolescent
lumbar disc herniation. Spine. 2008 Jul. 15;33(16):1750–1754.
• Copley LA, Dormans JP. Cervical spine disorders in infants and children. J Am Acad Orthop Surg. 1998
Jun.;6(4):204–214.
• Eubanks JD, Gilmore A, Bess S, Cooperman DR: Clearing the pediatric cervical spine following injury. J Am Acad
Orthop Surg 2006;14(9):552-564.
• Fielding JWHensinger RN, Hawkins RJ: Os odontoideum. J Bone Joint Surg Am 1980;62:376-383.
• Firth GB, Kingwell S, Moroz P. Pediatric Non-Contiguous Spinal Injuries: The 15 year Experience at One Pediatric
Trauma Centre. Spine. 2011 Nov. 14 (Ahead of Print)
• Jones TM, Anderson PA, Noonan KJ. Pediatric cervical spine trauma. J Am Acad Orthop Surg. 2011
Oct.;19(10):600–611.
• McCall T, Fassett D, Brockmeyer D. Cervical spine trauma in children: a review. Neurosurg Focus. 2006;20(2):E5.
• Parent S, Mac-Thiong J-M, Roy-Beaudry M, Sosa JF, Labelle H. Spinal cord injury in the pediatric population: a
systematic review of the literature. J. Neurotrauma. 2011 Aug.;28(8):1515–1524.
47. Bibliography
• Rumball K, Jarvis J. Seat-belt injuries of the spine in young children. J Bone Joint Surg Br. 1992 Jul.;74(4):571–
574.
• Sharma OP, Oswanski MF, Yazdi JS, Jindal S, Taylor M. Assessment for additional spinal trauma in patients with
cervical spine injury. Am Surg. 2007 Jan.;73(1):70–74.
• Shaw M, Burnett H, Wilson A, Chan O: Pseudosubluxation of C2 on C3 in polytraumatized children: Prevalence
and significance. Clin Radiol 1999;54(6): 377-380.
• Slotkin JR, Lu Y, Wood KB. Thoracolumbar spinal trauma in children. Neurosurg. Clin. N. Am. 2007
Oct.;18(4):621–630.
• Tarr RW, Drolshagen LF, Kerner TC, Allen JH, Partain CL, James AE. MR imaging of recent spinal trauma. J
Comput Assist Tomogr. 1987 Apr.;11(3):412–417.
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