Cervical burst fracture

Background

• For C1 burst fracture, see Jefferson fracture
• Unstable if:
  • Associated neurologic deficits
  • Loss of >50% of vertebral body height
  • >20 degrees of spinal angulation
  • Compromise of >50% of spinal canal
  • Axial compression > nucleus pulposus forced into vertebral body

Vertebral fractures and dislocations types

Vertebral anatomy.

Numbering order of vertebrae.

• Cervical fractures and dislocations
  • Atlanto-occipital dissociation
  • C1
    • Jefferson fracture
    • C1 isolated anterior arch fracture
    • C1 isolated posterior arch fracture
  • C2
    • Odontoid fracture
    • Hangman's fracture
  • C3-C7
    • Cervical burst fracture
    • Cervical spinous process fracture
    • Extension cervical teardrop fracture
    • Flexion cervical teardrop fracture
    • Anterior cervical wedge fracture
  • Cervical facet dislocation
  • Isolated transverse process fracture
• Thoracic and lumbar fractures and dislocations
  • Chance fracture
  • Thoracic burst fracture
  • Lumbar burst fracture
  • Isolated transverse process fracture
  • Thoracic and lumbar compression fractures

Clinical Features

• Neck pain in the setting of trauma
• Complete or incomplete spinal cord injury common

Differential Diagnosis

Neck Trauma

• Penetrating neck trauma
• Blunt neck trauma
  • Vertebral and carotid artery dissection
  • Strangulation
  • Whiplash injury
• Cervical injury
  • Cervical fractures and dislocations
  • Cervical injury (peds)
  • Cervical spine clearance
• Neurogenic shock
• Spinal cord injury

Evaluation

• Imaging
  • Lateral x-ray - Comminuted body and loss of vertebral height
  • AP x-ray - Vertical fracture of the body
  • Consider MRI - posterior ligament often injured

Management

• Prehospital Immobilization see NAEMSP National Guidelines for Spinal Immobilization

Disposition

• Generally admit

See Also

• Cervical spine injuries

References

Orthobullets