WIDI - CB1238-L1 chance fracture, radiograph

L1 chance fracture, radiograph

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0.5 CME Credit available on completion

POINT OF CARE INFORMATION

This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.

Learning Objectives

As a result of participation in this activity, participants should be able to:

Provide improved patient care.
Greater knowledge of the imaging characteristics of the patient's disease.
Understand a better approach to interpretation of studies.

Faculty Disclosure

Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.

CME Advisory Committee Disclosure:

Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.

Continuing Medical Education Credit

Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CB1238-L1 chance fracture, radiograph

History

19 yo male s/p MVA

Exam

frontal and lateral views of the lumbosacral spine

Prior Study

none

Findings

Technique

The lateral view is somewhat under penetrated, but can be adjusted by changing the window settings. The exam is limited by patient positioning on the lateral view and the lumbosacral junction is not entirely included.

Prevertebral and paravertebral soft tissues

The prevertebral or paravertebral soft tissues are normal.

Spinal alignment

The vertebral bodies are abnormally aligned on the lateral view at L1. The anterior and posterior vertebral body lines are interrupted from an L1 fracture with retropulsion of the posterior vertebral body margin.

The visualized spinous processes at T12-L1 are distracted on the AP and lateral views.

There is slight kyphosis at T12-L1.

Vertebral bodies, posterior elements, and included sacral segments

There are 5 non rib-bearing vertebral bodies.

There is a Chance type fracture of the L1 vertebral body extending into the posterior elements. There is anterior wedging and compression of the L1 vertebral body and end plates. There are also superior end plate fractures of L2 and L3.

There are fractures of the pedicles and lamina of L1 on the frontal and lateral views

The included sacral ala are normal.

Disc spaces and facet joints

There is disc space narrowing at T12-L1 and L1-L2.

There is evidence of abnormality of the facets at L1, possibly widening or rotational abnormality and dislocation

There is no facet joint narrowing or sclerosis or encroachment of the neural foramina other than from degenerative change.

Additional soft tissues and bones (lower thorax, abdomen, and pelvis)

The bowel gas pattern is normal.

The included thoracic spine, ribs, and lower chest are normal.

Other findings

There are no other existing conditions that might be contributing to symptoms which can or should be further evaluated non-emergently.

Impression

There is anterior wedging and compression of L1 and a Chance fracture of the L1 vertebral body extending into the posterior elements. There are also superior end plate fractures of L2 and L3.

Recommendations

The referring physician was contacted at the time of dictation and cross sectional imaging for further evaluation of an unstable Chance fracture of L1 was recommended.