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I have completed bits of my EM training from India. Currently I am boarded with credentials from Christian Medical College, Vellore and also from the prestigious Royal College of Emergency Medicine, UK.  I am currently working in London as an A&E doctor, trying to appreciate the differences in the practise and culture of Emergency Medicine across different healthcare systems. I have always been an avid FOAMed supporter because FOAMed played an indispensable role during the days of my initial training. Through this blog, I aspire to disseminate knowledge and stay up to date with the EM literature. 

Monday, January 30, 2017

AP View and Common C-Spine injuries - Part 3

Long AP view checklist
While interpreting the AP view of C-Spine, address these two questions:

1. Are all the spinous processes in a straight line? (Red and Blue vertical lines)
If not, consider a rotational injury.

2. Look for approximately equal height of each vertebra and also spaces between adjacent spinous processes? (Light green arrows and small blue X marks)

Common Fractures 
Most C-spine injuries are managed with immobilisation or surgical repair. Indications for surgical intervention are:

  1. Neurological Deficits
  2. Severe Pain
  3. Unstable Spine

Jefferson's fracture (burst # of atlas due to axial loading)
X-Ray display outward displacement of lateral masses on open-mouth view. It is treated with hallo immobilisation/ surgical repair. 

Hangman's fracture: Fracture of both pedicles of C2 that occurs due to hyperextension of neck. It is treated with halo immobilisation/ surgery. 

Odontoid (Peg) Fractures
Type 1 - Philadelphia collar
Type 2 - Halo vest/ Surgical Repair
Type 3 - Halo vest

Vertical Compression fracture (Treated with traction/immobilisation)

Unilateral facet dislocation: On a lateral view, the involved vertebral body will be displaced <50% of its width. On anterior view, there is rotation of the involved vertebra, with the affected spinous process pointing toward the side that is dislocated. 

Bilateral facet dislocation: The vertebral body is dislocated anteriorly at least 50% of its width. These injuries usually present with neurologic deficits. 

Clay Shoveler's fracture i.e. Avulsion off the end of one of the lower cervical spinous processes, classically describes with C7. Rx with a soft collar. 

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