#emorthoreview

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Posterior hip dislocation

Necessary XR views include an AP pelvis. CT scan should also be obtained to look for acetabular fractures, loose intra-articular fracture bodies or femoral head fractures. Reduction should occur within 6 hours due to avascular necrosis risk. The patient should be admitted to the hospital with orthopedic consultation for need for operative fixation.

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Hangman’s Fracture

One of the unstable C-spine fractures. Caused by hyperextension injury causing C2 to displace anterior over C3 (blue arrow) often due to bilateral C2 pedicle fractures. Pre-vertebral soft tissue swelling is noted suggesting disruption of the anterior longitudinal ligament (orange arrow). Pars interarticularis fractures are also noted by the red arrow. These patients are at risk for disruption of the posterior longitudinal ligament. This fracture typically heals with immobilization. 

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Jefferson Fracture

One of the unstable C-spine fractures. This is a burst fracture of C1 due to excessive axial loading where fractures occur through both the anterior and posterior arches. Radiographic findings on the odontoid view include lateral displacement of C1 relative to C2. Most patients do well with immobilization in a hard cervical collar. Complications include transverse ligament rupture, which is suggested by C1 lateral masses greater than 7mm wide. CT angiography is recommended if there is suspicion of vertebral artery injury. 

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Odontoid (dens) fracture, Type III

One of the unstable C-spine fractures. It occurs secondary to an extreme flexion or extension injury such as whiplash in a MVC. The odontoid process, also called the dens, is critical for C2/C1 articulation and allows for the large range of cervical motion our necks exhibit.  A type I fracture is an avulsion injury at the tip where the transverse ligament is intact , a type II fracture is a break at the base of the dens and a type III fracture extends into the body of C2 vetebrae Type I and III fractures typically only require a hard collar for 6 weeks. Type II is more unstable and may require a cervical Halo or a pin to keep the odontoid from having worsening displacement.