CLASIFICACION AO DE FRACTURAS PDF
Hundreds of surgical procedures, reductions, fixations and approaches. Surgical decision making made easy with literature evaluated and prepared for quick. Download scientific diagram | Distribución de las fracturas según la clasificación de AO. from publication: Clinical study of intramedullary and extramedullary. Download scientific diagram | Clasificación AO de la fractura. from publication: Fijación posterior monosegmentaria en fracturas de la columna toracolumbar.
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Most classification systems of spine injuries are based on injury mechanisms and describe fracturss the injury occurred. This is all based on the premise that a fracture caused by forward flexion should be treated by undoing the flexion by positioning the patient in an extension brace, or by surgical intervention correcting the spinal column in extension.
Some of the injuries thought to be due to extension mechanisms, however, turn out to be due to flexion and vice versa. These descriptions may thus be misleading. A problem with classifications such as the AO-classification is that they are usually complex, leading to high inter-reader variability.
Using the popular Denis three-column classification may lead oa another situation since it uses the terms stable and unstable. In many cases, however, there is no good correlation with the necessity for surgery. Furthermore, the word stability itself is ambiguous and may refer to zo osseous stability; it may refer to neurological stability and finally, to long-term ligamentous stability. Both of these commonly used systems fail to systematically take into account the neurological status of the patient and the indication for MRI to determine the integrity of the posterior ligamentous complex.
For these reasons the Spine Trauma Study Group introduced in the Thoracolumbar Injury Classification and Severity Scale 1with intention to be a reliable, ease-to-use tool to facilitate clinical decision making and as a practical alternative to cumbersome classification systems already in use. A parameter can be scored points and the total score is the sum of these parameters with a maximum of 10 points.
A total of more than 4 points indicates surgical treatment. In case of a distraction on the anterior side, however, the PLC may or may not be involved, i. Usually the morphology matches the injury frscturas, but sometimes it does not. Once you realize that, it should not confuse you. The PLC serves as a posterior “tension band” of the spinal column and plays an important role in the stability of the spine 3. The PLC is composed of the supraspinous ligaments, interspinous ligaments, articular facet capsules, and ligamenta flava figure.
The supraspinous ligament is a strong, cordlike ligament which connects the tips of the spinous processes from C7 to the sacrum.
The interspinous ligaments are weak, thin, membranous structures connecting the adjacent spinous processes. The contractile force of the ligamenta flava presses the vertebrae together and keeps them aligned. Since the integrity of the PLC depends mostly on ligamentous structures, MR is sometimes needed to adequately diagnose pathology of the PLC, especially when there is no dislocation or disruption on CT. In some cases it can be difficult to decide whether there is a burst fracture with a torn PLC or distraction with a torn PLC and a compression fracture figure.
You have to decide what you think is the main issue: Since in both cases the TLICS score based on imaging will be high, there is usually an indication for surgical treatment. One of the key points here is that an incomplete cord lesion will likely benefit more from surgery than a complete lesion; therefore a complete cord injury is scored as only 2 points, while an incomplete cord injury gets 3 points.
Sternum fracture The image shows a vertebral fracture with a transverse fracture of the spinous process, but also a fracture of the sternum. Analogous to the 3-column classification of Denis, some investigators consider the sternum as the fourth column in upper thoracic spinal fractures and recognize it as an independent variable in the assessment and treatment of these patients 5. Patients with a rigid spine such as in ankylosing spondylitis, DISH and rheumatoid arthritis are more susceptible to spinal fractures, even after minimal trauma 6.
Ossification of the spinal ligaments and calcification of the annulus fibrosus alter the biomechanics of the spine, creating long lever arms and limiting the ability to absorb even minor impacts. However the CT shows a thin fracture line through the anterior side of the vertebral body and also through the spinous process.
AO/OTA Fracture and Dislocation Classification Compendium
It is either loss of height of the anterior part of the vertebral body or disruption of the vertebral endplate. Clasificadion posterior cortex of the vertebral body has to be intact and this feature differentiates a simple fractursa fracture from the more severe burst fracture.
The posterior cortex may bulge slightly posteriorly in a simple compression fracture. As long as there is no free fragment with posterior displacement, it is a wedge compression fracture and not a burst fracture.
All we see is a cortical disruption in the upper anterior wall of the vertebral body and slight loss of height ventrally. Notice that on a 2. You have to look at the thin slices to detect such a subtle fracture. Notice the horizontal band of density, clasificacoin is often described as sclerosis.
This density does not mean that it involves an older fracture that is already healing with sclerosis. This is merely a sign of trabecular impaction in an acute fracture. This is the severe variant of a compression fracture with higher risk of neurologic deficits. Claxificacion name is derived from the typical fracture following a fall from height and landing on the feet.
Spine injury – TLICS Classification
This means that a patient can be treated non-surgically. In the absence of a neurologic deficit, PLC integrity should be confirmed at MR imaging, especially if conservative management of a burst fracture is planned 3. In the Denis classification a burst fracture is classified as a two-column injury, calling it unstable and requiring surgical stabilization. Subsequent modifications of the Denis classification have recognized that with an intact posterior ligamentous complex PLCtwo-column unstable injuries can be successfully treated non-surgically 3.
Retropulsion of a fragment is the typical feature of a burst fracture and distinguishes it clearly from a simple compression fracture.
Sagittal fracture of vertebral body and posterior element.
The treatment will depend on the PLC integrity and the neurological status. On the AP-view notice the subtle widening of the interpedicular distance compared to the levels above and below. The anterior longitudinal ligament is disrupted. If there was a lot of fluid in the joint, we should call this indeterminate. In this case we are not sure. You could argue that these fractures of the spinous processes indicate distraction, i. However in this case the compression is the most prominent finding.
This type of fracture includes all fractures that are the result of displacement in the horizontal plane: In the TLICS fracturae means 3 points for the morphology and 3 points for the PLC, which makes a total of 6 points indicating the need for surgical stabilization. Here a typical case of translation.
The Radiology Assistant : Spine injury – TLICS Classification
The x-ray of the Clasificaxion in this patient was normal and did not show the fracture. First look at the first CT-images and decide what is going on.
Then scroll to the next images. In this case of translation there is bilateral facet dislocation and also a horizontal fracture of the spinous process.
There is severe narrowing of the spinal canal. In some cases it can be difficult to decide whether there is a translation or distraction injury and we have to assume that the traumtic mechanism is a combination of forces.
Even though there is not much displacement at this moment, we should probably call this translation injury. So we should call this a translation fracture with anterior displacement. A distraction injury is separation or pulling apart of two adjacent vertebrae.
It is a severe injury since fractuas is a high chance of cord injury when its osseous and ligamentous supporting structures are pulled apart. A distraction injury on the posterior side can lead to a compression fracture on the anterior side.
So be sure not to underestimate the injury by only looking at the compression fracture and overlooking the distraction injury. In some cases it is difficult to decide whether you are dealing with distraction combined with a compression fracture or with a compression fracture with PLC-injury.
If the distraction is the main feature, then the morphology is distraction, i. If compression is the main feature, then the morphology is burst, i.
In both cases the patient is a surgical candidate. In this case the main findings are the horizontal fractures of the posterior elements. The vertebral body fractures show hardly any compression. In this case there is severe compression of the vertebral body.
However the most important findings are the horizontal fractures of the posterior elements. In this case some would call this a burst fracture with PLC-injury i. However the distraction is the most important finding, i. The facet joints are separated on both sides.
There is a spinous process fracture, which is not a key element but a frequently associated injury. Frequently when you have a good CT, you have most of the anatomic information. The MRI also shows disruption of the ligamentum flavum and a partial disruption of the interspinous ligament. At first glance the AP-view doesn’t look very odd. That is until we zoom in and look at the distance between the spinous processes.
You can see the edema related to the fracture of the vertebral body and the massive edema in the paraspinous muscles. This is an interesting case since non-surgical management was initially attempted in this patient.
There is loss of height with a dense band of impaction and there is an anterosuperior corner fracture on both levels. But look at the spinous processes. One of the clasifcacion processes is in two pieces and the two pieces are widely clasificwcion. So this is a distraction fracture, also known as Chance fracture. Now when you describe fracturzs a fracture the first word in your report should be distractioni.
There is widening between the spinous processes. But there are also little pieces of bonethat have avulsed at least 10mm away. At first we thought that little pieces of bone didn’t matter, but they may be the most important sign of a major injury on a CT-scan.
The fact that these little pieces of bone have been so severely displaced means there has to be a major injury. Now in this case there are lots of other things going on, but sometimes these little pieces of bone are all you get.
The MRI demonstrates rupture of the flava ligaments, interspinous and supraspinous ligaments as clasificadion as fracture of the posterior elements and compression of the vertebral body.