C2 fracture

Dec 16, 2018Download as PPTX, PDF1 like860 views

C2 fractures can range from asymptomatic to paralysis and are often caused by motor vehicle accidents or falls. Higher level cervical spine injuries carry greater risks. C2 fractures include odontoid fractures, lateral mass fractures, extension teardrop fractures, and traumatic spondylolisthesis (hangman's fracture). Diagnosis involves imaging like X-rays and CT/MRI to classify the fracture. Treatment depends on fracture type and severity but may include immobilization, traction, internal fixation, or fusion surgery. Complications can include malunion, nonunion, or pseudarthrosis if not properly treated.

Background
Cervical spine (C-spine) injuries are the most feared of all spinal injuries
because of the potential for significant deleterious sequelae.
Relation,
higher the level of the C-spine injury higher the morbidity and
mortality
Craniocervical junction injuries are the deadliest.

$MVA and fall are responsible for bulk of C2 fracture. The clinical manifestations range from asymptomatic to frank paralysis. Motor Vehicle Accident ER(unconscious patient) C-spine pathology (10%)$

Anterior arch of C1
1. Stabilizes central atlantoaxial joint +odontoid process
2. Resistant against horizontal displacement of atlas
Dentate ligament (dens to clivus)
Alar ligaments (transverse ligament to foramen
magnum) Rotational and translational stability

$Odontoid Fractures (15%) type I (<5%) -oblique fracture -through the upper part of the odontoid process type II (>60%) -base of the odontoid type III (30%) -occurs when the fracture line extends through the body of the axis.$

Mechanism: precise unknown, flexion, extension, rotation
History:
1. Pain
2. Inability to actively move the neck
3. Sensation of instability (feeling of head being unstable on spine)
4. Holding head with hand to prevent motion
Examination:
Quadriplagia with respiratory system involvement to minimal upper-
extremity motor and sensory deficit secondary to loss of one or more
cervical nerve roots.

$C2 lateral mass fractures Mechanism: Axial compression with concomitant lateral bending$

$C2 extension teardrop fractures -are avulsion fractured with intact anterior longitudinal ligament displacing and anteriorly rotating antero inferior vertebral body fragment Mechanism: extension, or very severe flexion forces -elderly with osteoporotic bone$

$Traumatic spondylolisthesis of C2 (hangman fracture) -is bilateral pedicle fracture of C2, along with distraction of C2 from C3 secondary to complete disruption of disk and ligament of C2 and C3 Mechanism: Hyperextension with axial compression and lateral flexion (Extension + Distraction)$

Physical Examination
Motor
• Sternocleidomastoid (SCM)
• Trapezius
Reflex
SCM reflex, by tapping on
clavicular end of muscle
Sensory
• Posterior scalp
• Anterolateral neck
• Antero inferior & postero
inferior external ear

Clinical Examination
• Observe and palpate deformities and step-offs
• Test muscle strength and tone of upper and lower extremities
• Perform sensory on upper and lower extremities
• Perform rectal examination
• Test trapezius muscles by asking patient to shrug shoulders
• Observe for torticollis

Imaging Studies: AP/Lat/Odontoid views
Xray C-spine (1st choice)
CT C-spine (extent of injury)
MRI (soft tissue injury, neural element
injury and disk injury)

$Classification (Levine and Edwards) Based on degree of displacement on lateral C-spine radiographs and on mechanical stability I: bilateral pedicle fracture <3mm of anterior C2 body displacement no angulation II significant displacement significant angulation IIA No anterior displacement Severe angulation III Severe displacement Severe angulation$

Odontoid Fractures
I
1. Hard-collar immobilisation for 6-8
weeks
II & III
(conservatively or surgically)
1. Halo immobilisation
2. Internal fixation (odontoid screw
fixation)
3. Posterior atlantoaxial arthrodesis
Complications:
Malunion, non union, pseudoarthosis

$C2 lateral mass fractures Ranges from collar immobilisation to cervical traction followed by halo immobilisation.$

$C2 extension teardrop fractures Cervical orthosis$

Classification (Levine and Edwards)
I
Philadelphia collar or halo
II
1. Halo or tong traction
in weighted extension
(closed reduction &
traction)
2. Open reduction with
cervical plating
3. Internal fixation with
C2 transpedicular screw
IIA
1. Closed reduction then
halo-vest
2. C2 transpedicular
screw
3. Anterior cervical
plating
III
Surgical reduction and
stabilisation

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In vitro means production in a test tube or other similar vessel where culture conditions and medium are controlled for optimum growth during tissue culture. It is a critical step in plant tissue culture where roots are induced and developed from plant explants in a controlled, sterile environment. Slide include factors affecting In-vitro Rooting, steps involved, stages and In vitro rooting of the two genotypes of Argania Spinosa in different culture media.

Detection of ferrihydrite in Martian red dust records ancient cold and wet co...Sérgio Sacani

Iron oxide-hydroxide minerals in Martian dust provide crucial insights into Mars’ past climate and habitability. Previous studies attributed Mars’ red color to anhydrous hematite formed through recent weathering. Here, we show that poorly crystalline ferrihydrite (Fe5O8H · nH2O) is the dominant iron oxidebearing phase in Martian dust, based on combined analyses of orbital, in-situ, and laboratory visible near-infrared spectra. Spectroscopic analyses indicate that a hyperfine mixture of ferrihydrite, basalt and sulfate best matches Martian dust observations. Through laboratory experiments and kinetic calculations, we demonstrate that ferrihydrite remains stable under present-day Martian conditions, preserving its poorly crystalline structure. The persistence of ferrihydrite suggests it formed during a cold, wet period on early Mars under oxidative conditions, followed by a transition to the current hyper-arid environment. This finding challenges previous models of continuous dry oxidation and indicates that ancient Mars experienced aqueous alteration before transitioning to its current desert state.

PROTEIN DEGRADATION via ubiquitous pathawayKaviya Priya A

Protein degradation via ubiquitous pathway In general science, a ubiquitous pathway refers to a biochemical or metabolic pathway that is: 1. *Widely present*: Found in many different organisms, tissues, or cells. 2. *Conserved*: Remains relatively unchanged across different species or contexts. Examples of ubiquitous pathways include: 1. *Glycolysis*: The process of breaking down glucose for energy, found in nearly all living organisms. 2. *Citric acid cycle (Krebs cycle)*: A key metabolic pathway involved in energy production, present in many cells. 3. *Pentose phosphate pathway*: A metabolic pathway involved in energy production and antioxidant defenses, found in many organisms. These pathways are essential for life and have been conserved across evolution, highlighting their importance for cellular function and survival.

Plant Tissue Culture-Effects of Chemical Factors.pptlaxmichoudhary77657

2025-03-03-Data-related-Ethics Issues in Technologies for Professional Learni...Graz University of Technology & Know-Center

How could modern LA research address data-related ethics issues in informal and situated professional learning? I will identify in this talk three relevant insights based on field studies around workplace LA interventions: Firstly, in informal and situated learning, data isn’t just about the learners. Secondly, the affordances of manual and automatic data tracking for learning are very different, with manual tracking allowing a high degree of learner control over data. Thirdly, learning is not necessarily a shared goal in workplaces. These can be translated into seeing a potential for systems endowed with sufficient natural-language-processing capability (now seemingly at our fingertips with LLMs), and socio-technical design and scenario-based data collection analysis as design and research methods.

(Journal Club) Folding DNA to create nanoscale shapes and patternsDavid Podorefsky, PhD

GRAPHS BIOSTATICS BPHARM 8 SEM UNIT 1 & 3.pptxKRUTIKA CHANNE

Direct Gene Transfer Techniques for Developing Transgenic PlantsKuldeep Gauliya