Most common pattern cord injury
Hyper-extension injury in middle aged man with osteoarthritic spine
Usually C3/4 and C4/5
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
Facet joint dislocations secondary flexion distraction injury
10%
1. Unifacet subluxation - interspinous process widening
2. Unifacet dislocation - 25% anterolisthesis
3. Bifacet dislocation - 50% anterolisthesis
4. Complete vertebral translation - 100% anterolisthesis
Disseminated Intravascular Coagulation
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
High energy usually
Occasionally osteoporotic fracture in elderly
Other
- radiotherapy
- fatigue fracture in children
Don't present as isolated injury
- associated with pelvic fracture
Zone 1
- lateral to foramina
- neurologic injury from proximal migration & compression of L5 nerve root
Transient disturbance of spinal cord function
- +/- vertebral column injury
- no pathological changes in spinal cord
Rapid change in velocity following trauma
- football / ice hockey
Congenitally narrow spinal cord
Hypermobility
Direct blow
- most common
Indirect
- forced knee flexion with foot fixed / maximally contracted quadriceps
1. Vertical
2. Transverse
Repetitive friction of iliotibial tract over GT
Overuse in athletes
Common post THR
May be associated with gluteus medius tears
Pain over upper lateral thigh with activity
- often related to hip flexion
Hyper-dorsiflexion injury to 1st MTP joint
Grade 1 - Mild sprain
Symptoms
- minimal swelling / ecchymosis
Management
- return to play immediately
- RICE / NSAIDS
Grade 2 Partial tear plantar plate
Symptoms
6 /100 000
- second most common dislocation after shoulder
FOOSH
Extremely uncommon
Stability provided by joint capsule /costoclavicular & interclavicular ligaments
Recurrent instability uncommon
Many apparent dislocations in adolescents may be growth plate injuries
-will remodel without treatment
If OA from chronic dislocation may resect SCJ