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Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation: a narrative review and proposed treatment algorithm
(2024)
Juan Ignacio Cirillo
;
Guillermo A Ricciardi
;
Facundo Lisandro Alvarez Lemos
;
Alfredo Guiroy
;
YURAC BARRIENTOS, RATKO JOVAN
<jats:p> <jats:list list-type="bullet"> <jats:list-item> <jats:p>Isolated cervical spine facet fractures are often overlooked.</jats:p> </jats:list-item> <jats:list-item> <jats:p>The primary imaging modality for diagnosing these injuries is a computed tomography scan.</jats:p> </jats:list-item> <jats:list-item> <jats:p>Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation remains controversial. The available evidence regarding treatment options for these fractures is of low quality.</jats:p> </jats:list-item> <jats:list-item> <jats:p>Risk factors associated with the failure of nonoperative treatment are: comminution of the articular mass or facet joint, acute radiculopathy, high body mass index, listhesis exceeding 2 mm, fragmental diastasis, acute disc injury, and bilateral fractures or fractures that adversely affect 40% of the intact lateral mass height or have an absolute height of 1 cm.</jats:p> </jats:list-item> </jats:list></jats:p>
Scopus© Citations 3 1
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Variations in management of A3 and A4 cervical spine fractures as designated by the AO Spine Subaxial Injury Classification System
(2022)
Barry Ting Sheen Kweh
;
Jin Wee Tee
;
Sander Muijs
;
F. Cumhur Oner
;
Klaus John Schnake
<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Optimal management of A3 and A4 cervical spine fractures, as defined by the AO Spine Subaxial Injury Classification System, remains controversial. The objectives of this study were to determine whether significant management variations exist with respect to 1) fracture location across the upper, middle, and lower subaxial cervical spine and 2) geographic region, experience, or specialty.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A survey was internationally distributed to 272 AO Spine members across six geographic regions (North America, South America, Europe, Africa, Asia, and the Middle East). Participants’ management of A3 and A4 subaxial cervical fractures across cervical regions was assessed in four clinical scenarios. Key characteristics considered in the vignettes included degree of neurological deficit, pain severity, cervical spine stability, presence of comorbidities, and fitness for surgery. Respondents were also directly asked about their preferences for operative management and misalignment acceptance across the subaxial cervical spine.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>In total, 155 (57.0%) participants completed the survey. Pooled analysis demonstrated that surgeons were more likely to offer operative intervention for both A3 (p < 0.001) and A4 (p < 0.001) fractures located at the cervicothoracic junction compared with fractures at the upper or middle subaxial cervical regions. There were no significant variations in management for junctional incomplete (p = 0.116) or complete (p = 0.342) burst fractures between geographic regions. Surgeons with more than 10 years of experience were more likely to operatively manage A3 (p < 0.001) and A4 (p < 0.001) fractures than their younger counterparts. Neurosurgeons were more likely to offer surgical stabilization of A3 (p < 0.001) and A4 (p < 0.001) fractures than their orthopedic colleagues. Clinicians from both specialties agreed regarding their preference for fixation of lower junctional A3 (p = 0.866) and A4 (p = 0.368) fractures. Overall, surgical fixation was recommended more often for A4 than A3 fractures in all four scenarios (p < 0.001).</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The subaxial cervical spine should not be considered a single unified entity. Both A3 and A4 fracture subtypes were more likely to be surgically managed at the cervicothoracic junction than the upper or middle subaxial cervical regions. The authors also determined that treatment strategies for A3 and A4 subaxial cervical spine fractures varied significantly, with the latter demonstrating a greater likelihood of operative management. These findings should be reflected in future subaxial cervical spine trauma algorithms.</jats:p> </jats:sec>
17Scopus© Citations 3
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Surgical timing prevails as the main factor over morphologic characteristics in the reduction by ligamentotaxis of thoracolumbar burst fractures
(2023)
Juan Ignacio Cirillo
;
Ignacio Farias
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Cristóbal Del Pino
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Marcos Gimbernat
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Alejandro Urzúa
<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>thoracolumbar burst fractures are associated with spinal canal occupation. The indirect decompression of the spinal canal and reduction of the fragment can be achieved with the distraction of the middle column and ligamentotaxis. Nevertheless, the factors that influence the effectiveness of this procedure and its temporality are controversial.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>The aim of this observational, cross-sectional study was to evaluate the effectiveness of indirect reduction by ligamentotaxis in thoracolumbar burst fractures according to the fracture’s radiologic characteristics and the procedure’s temporality. Patients diagnosed with a thoracolumbar burst fracture between 2010 and 2021 were submitted to indirect reduction by distraction and ligamentotaxis. A retrospective analysis of radiologic characteristics and temporality of the procedure was performed with an independent sample t-test or Pearson’s correlation coefficient, as required.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 58 patients were included in the analysis. Postoperatively, ligamentotaxis significantly improved all radiologic parameters (canal occupation, endplates distance, and vertebra height). Still, none of the radiological characteristics of the fracture (width, height, position, sagittal angle) were associated with the postoperative change in canal occupation. The endplates distance and the temporality of ligamentotaxis significantly predicted the reduction of the fracture.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Fragment reduction effectiveness is more significant when performed as early as possible and adequate distraction is achieved using the internal fixator system. The radiologic characteristics of the fractured fragment do not determine its reduction capacity.</jats:p> </jats:sec>
1Scopus© Citations 3 2
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Minimally Invasive Versus Open Surgery for the Treatment of Types B and C Thoracolumbar Injuries: A PRISMA Systematic Review
(2021)
Charles André Carazzo
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YURAC BARRIENTOS, RATKO JOVAN
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Alfredo Guiroy
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Juan J. Zamorano
;
Juan P. Cabrera
Scopus© Citations 11 4
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Traumatic cervical spine injury due to pole dance accident: A potentially catastrophic unreported injury with a happy ending. Case report and literature review
(2022)
YURAC BARRIENTOS, RATKO JOVAN
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ZAMORANO PÉREZ, JUAN JOSÉ
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Andrea Marre
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Cristian Diaz
<jats:sec id="st1"> <jats:title>Background: </jats:title> <jats:p>Pole dancing is a sport that has become very popular. However, there is scarce literature on injuries associated with this sport. Here, we present a 23-year-old female who sustained a traumatic C4-C5 vertex cervical spine injury caused by a fall of 1 m while practicing pole dancing in an inverted position, requiring a 360 decompression/fusion.</jats:p> </jats:sec> <jats:sec id="st2"> <jats:title>Case Description: </jats:title> <jats:p>A 23-year-old female sustained a 1 m fall in an inverted position while pole dancing resulting in a direct axial impact to the head. She developed the rapid onset of quadriparesis that was attributed to the emergent CT/MR-documented cervical flexodisruptive luxofracture (AOSpine C4-C5 fracture: C, F4 unilateral, N3, M2). Four hours post injury, she underwent a C4-C5 anterior cervical discectomy and fusion. Four days later, a posterior fusion was performed to add to the stabilization. Six years later, the patient remains neurologically intact.</jats:p> </jats:sec> <jats:sec id="st3"> <jats:title>Conclusion: </jats:title> <jats:p>Pole dance is an emerging sport which carries a risk of cervical spine injury.</jats:p> </jats:sec>
Scopus© Citations 1 1
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Reparación simbólica, trauma y victimización: la respuesta del Estado chileno a las violaciones de derechos humanos (1973-1990)
(2020)
Javiera Bustamante Danilo
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CARREÑO CALDERON, ALEJANDRA ANGELICA
<jats:p>Pasados más de 30 años desde el fin de la dictadura cívico-militar, pocas investigaciones han abordado el rol que la categoría de víctima ha asumido en las estrategias que el Estado chileno puso en marcha desde 1990 en adelante para abordar las violaciones a derechos humanos acaecidas entre 1973 y 1990. A partir del análisis documental y etnográfico de las políticas de reparación simbólica y de las normativas asociadas con programas de beneficios sociales y sanitarios, este artículo explora la forma en que el Estado chileno ha administrado las violaciones a derechos humanos, la tortura y la desaparición, basándose en dos principios: la narrativa de la victimización y la adopción de una perspectiva individualizada en el abordaje del trauma. A partir de un análisis de material documental y etnográfico, la investigación evidencia cómo este tratamiento ha marcado la agenda pública en materia de derechos humanos permitiendo soslayar, por una parte, la demanda por el esclarecimiento del destino de los cuerpos de los detenidos desaparecidos y, por otra, el reconocimiento del rol que tuvo el Estado en la perpetración de violencia durante la dictadura cívico-militar. Este análisis demuestra que, si bien la utilización de la figura de la víctima ha contribuido a aislar a las personas que sufrieron vejaciones y despolitizar su actuar, es necesario aún problematizar la potencialidad de acción colectiva que posee la victimización y sus posibles diálogos con los movimientos sociales contemporáneos.</jats:p>
Scopus© Citations 9 1
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Traumatic Events Exposure and Psychological Trauma in Children Victims of War in the Gaza Strip
(2021)
Antonio L. Manzanero
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María Crespo
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Susana Barón
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Teresa Scott
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Sofián El-Astal
<jats:p>The present article studies war-related trauma and its effects on children living in the Gaza Strip, 6 months after the attack launched by the Israeli army on July 8, 2014, which lasted for 51 days. The objective was twofold: (a) to identify the prevalence of exposure to traumatic events and (b) to examine the symptoms of traumatic stress in children as described by their parents or tutors using the Harvard Trauma Questionnaire (HTQ). Data from 1,850 male and female children aged between 6 and 15 years living in the Gaza Strip were collected throughout the months of February and April 2015, that is 6 months after the attack. Results showed that the majority of the children were exposed to bombardments and residential area destruction (83.51%), were confined at home unable to go outside (72.92%), were witness to the profanation of mosques (70.38%), were exposed to combat situations (66.65%), and saw corpses (59.95%). A sample of 275 males (28.3%) and 232 females (26.5%) showed diagnoses of posttraumatic stress disorder (PTSD). Gender and age were independent of PTSD. The presence of this pathology was positively related to the number of trauma events experienced. The type of traumatic experience was hardly related to age and gender. A greater protection on behalf of the families against exposure to traumatic events could explain these differences.</jats:p>
3Scopus© Citations 28
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SOFT-TISSUE INJURY TO THE FOOT AND ANKLE: LITERATURE REVIEW AND STAGED MANAGEMENT PROTOCOL
(2019)
Alexandre Leme Godoy-Santos
;
Tim Schepers
;
Cristian Ortiz
<jats:p>ABSTRACT Complex trauma of the foot and ankle is characterized by fractures with severe soft tissue damage associated with neurovascular injury and joint involvement. These injuries are frequently present in the polytraumatized patient and are a predictor of unfavorable clinical outcome. In the initial approach to a patient with complex foot and ankle trauma, the decision between amputation and reconstruction is crucial. The various existing classification systems are of limited effectiveness and should serve as tools to assist and support a clinical decision rather than as determinants of conduct. In the emergency department, one of two treatment options must be adopted: early complete treatment or staged treatment. The former consists of definitive fixation and immediate skin coverage, using either primary closure (suturing) or flaps, and is usually reserved for less complex cases. Staged treatment is divided into initial and definitive. The objectives in the first phase are: prevention of the progression of ischemia, necrosis and infection. The principles of definitive treatment are: proximal-to-distal bone reconstruction, anatomic foot alignment, fusions in severe cartilage lesions or gross instabilities, stable internal fixation and adequate skin coverage. Level of evidence III, Systematic review of level III studies.</jats:p>
Scopus© Citations 7 1

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