mechanism

Epidemiology

National Spinal Cord Injury Statistical Center (2021) Facts and figures at a glance

- road traffic accident 40%

- falls 30%

- sports 10%

Chen et al Arch Phys Med Rehab 2016

- 80% male

- cervical (60%), thoracic (30%), lumbar (10%)

Definition

Unstable injuries

Complete disruption of both the anterior and posterior ring

Cause

Movement of iliopsoas tendon over femoral head / iliofemoral ridge / iliofemoral ligament

Types

1.  Capsular avulsions

2.  Body / Nutcracker fracture

Nutcracker fracture

Epidemiology

- rare

Mechanism

- forced eversion / abduction of forefoot

- cuboid crushed between 4th and 5th MT and calaneum

Pathology

- displaced cuboid fracture with subluxation of tarsus

Definition

Coronal plane fracture of distal femoral condyle

- intra-articular

- often only attachment is posterior capsule

Epidemiology

Rare

Mechanism

Usually a severe valgus trauma

Xray

Epidemiology

Most common pattern cord injury

Hyper-extension injury in middle aged man with osteoarthritic spine

Usually C3/4 and C4/5

Mechanism

Most common type / in older patient with pre-existing spondylosis / OPLL

- hyperextension injury

- compression of the cord

- anteriorly by osteophytes

- posteriorly by infolded ligamentum flavum

Definition

Facet joint dislocations secondary flexion distraction injury

Epidemiology

10%

Stages

1. Unifacet subluxation - interspinous process widening

2. Unifacet dislocation - 25% anterolisthesis

3. Bifacet dislocation - 50% anterolisthesis

4. Complete vertebral translation - 100% anterolisthesis

Unilateral Facet Joint Dislocation

Definition

Disseminated Intravascular Coagulation

Pathology

Results from excessive activation of either extrinsic or intrinsic coagulation pathway

- multiple small clots 

- consumptive coagulopathy

1.  Excessive Extrinsic Activation

Secondary to extensive cellular destruction

- thromboplastins +++ released into circulation