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Atlanto-occipital dislocation

Atlanto-occipital dislocation. Findings: anterior and superior displacement of occipital condyles in relation to C1 pre-vertebral soft tissue swelling mechanism: hyperflexion or hyperextension UNSTABLE. Bilateral jumped facets. Findings: complete anterior dislocation of C5 on C6

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Atlanto-occipital dislocation

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  1. Atlanto-occipital dislocation • Findings: • anterior and superior displacement of occipital condyles in relation to C1 • pre-vertebral soft tissue swelling • mechanism: hyperflexion or hyperextension • UNSTABLE

  2. Bilateral jumped facets • Findings: • complete anterior dislocation of C5 on C6 • locked bilateral facets • disruption of ALL & PLL • “bat wing” appearance • mechanism: extreme hyperflexion • UNSTABLE

  3. Unilateral jumped facet • Findings: • anterolisthesis of C5 on C6, less than 50% • discordant rotation (C2-5 bodies appear smaller than C6-7) • C5 inferior facet perched on C6 superior facet • mechanism: flexion and rotation • STABLE

  4. Flexion teardrop fracture • Findings: • anterior teardrop fragment of C5 • prevertebral soft tissue swelling • widening of C5-C6 interspinous distance • mechanism: hyperflexion and compression (diving accident) • UNSTABLE

  5. Hangman’s fracture • Findings: • bilateral C2 pars fractires • anterolisthesis and forward tilting of the C2 body • prevertebral soft tissue swelling • may see avulsion of anterior inferior C2 • mechanism: hyperextension • UNSTABLE

  6. Jefferson fracture • Findings: • burst fracture of C1 • lateral view: lateral displacement of lateral masses > 2mm • mechanism: axial load injury • UNSTABLE

  7. Odontoid fracture • Findings: • base of dens fracture • anterior and superior distraction of dens and atlas • prevertebral soft tissue swelling • mechanism: hyperflexion • UNSTABLE

  8. Anterior shoulder dislocation • Findings: • inferomedial, subcoracoid position of the humeral head • too much overlap of humeral head and glenoid • axillary view shows Hill Sachs - Bankhart configuration • ddx: • NONE! • This is an Aunt Minnie!

  9. Bennett Fracture • Findings: • Vertical oblique intra-articular fracture at the base of the thumb MC • Radial subluxation of distal fragment • must be fixed surgically • ddx: • NONE! • This is an Aunt Minnie!

  10. Chauffer’s fracture(Hutchinson fracture) • Findings: • intra-articular radial styloid fracture • mild widening of SL distance • direct injury to the thenar side of wrist • ddx: • NONE! • This is an Aunt Minnie!

  11. Radial head fracture • Findings: • Visualization of both the anterior and posterior fat • “spinnaker sign” • most common adult elbow fracture • assume radial head fracture even if not clearly seen • ddx: • NONE! • This is an Aunt Minnie!

  12. Capitellum fracture-dislocation • Findings: • fracture-dislocation of the capitellum • due to direct trauma • second most common site in kids (most common is suprcondylar) • ddx: • NONE! • This is an Aunt Minnie!

  13. Medial epicondyle fracture(Little Leaguer’s elbow) • Findings: • small avulsion of the medial epicondyle • due to large valgus forces • little league pitchers • ddx: • NONE! • This is an Aunt Minnie!

  14. Galeazzi fracture-dislocation • Findings: • Angulated distal radius and ulna fractures • Distal ulnar dislocation • ddx: • NONE! • This is an Aunt Minnie!

  15. Monteggia fracture- dislocation • Findings: • Overlapping, angulated fracture of the proximal ulna • radial head dislocation • ddx: • NONE! • This is an Aunt Minnie!

  16. Rolando fracture • Findings: • comminuted intra-articular fracture of the thumb MC • ddx: • NONE! • This is an Aunt Minnie!

  17. Nail bed injury • Findings: • incomplete fracture of the dorsal distal phalanx • involves the nail bed • treat as open fracture • high risk of osteomyelitis • ddx: • NONE! • This is an Aunt Minnie!

  18. Dialysis arthropathy • Findings: • Multiple erosions on both sides of multiple PIP joints • Osteopenia, fuzzy trabecula, and dialysis graft = evidence of ESRD • ddx: • Inflammatory arthritis

  19. Femoral Head AVNwith collapse • Findings: • Mixed sclerotic and lytic appearance of the femoral head • 2 mm collapse of the superior articular surface • Joint space still preserved • ddx: • NONE! • This is an Aunt Minnie!

  20. Hemophilia • Findings: • Severe secondary arthritis of the ankle • ddx: • Inflammatory • Post-infectious

  21. Juvenile Rheumatoid Arthritis • Findings: • Flared metaphyses • Gracile diaphyses • Joint space narrowing • Abnormal patellae • ddx: • NONE! • This is an Aunt Minnie!

  22. Inflammatory Arthritis • Findings: • Severe joint space narrowing • Sub-chondral cystic changes and sclerosis • No significant osteophyte formation • ddx: • Post-infectious

  23. Odontoid fracturewith C1 subluxation • Findings: • 5mm anterior subluxation of C1 relative to C2 with flexion • ddx: • Destroyed dens • Rheumatoid • Metastasis

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