[Music] so as far as different types of of fractures [Music] that we deal with even the cervical spine has very peculiar types of fractures that can happen um and different ways of dealing with them occiput to see two the cranial cervical dissociation where literally you can have an eternal decapitation um c1 jefferson type fracture it's a fracture of the ring itself a c2 a dauntoid fracture these can be fractured in various ways that that little tooth sticks upright that can be fractured off a type 2 where it kind of fractures just that the dens is the most common in the hemings fracture which is kind of an explosive injury it's the ring of c2 that results from an axial looting on the head and usually some kind of motion forwards or back that explodes the ring of c2 and depending on the type of that they're very often not a neurologic injury because it's an expansion of the canal they're just unstable because the head's sort of flopping on its own column versus the rest of the posterior spinal canal that becomes disconnected with it this is an example of the the first it's mostly a ligamentous injury and more and more of these patients they used to die in a field but more and more of these patients are coming to our trauma center and man ems does an amazing job they do an amazing job uh in our trauma resuscitation unit where the patients first presented shock trauma and you can just even see the record prior to um [Music] going to see the patient that they're multiple arrests because they are uh have a very high medullary um almost brainstem type of injury um and they're completely pleasant they've affected their respiratory and cardio accelerator centers these are tough patients um but we're seeing more and more of them um make it to the to the hospital uh c1 jefferson fracture as i mentioned is a fracture usually again to actual loading to explode the ring of c1 the deltoid fracture here is a pretty brutal c2 dense type 2 dense fracture it's actually pretty well aligned now and you could treat this either through an untaunted screw or posteriorly by posterior fusion in a hangman's fracture this is a pretty bad one um in a bad dense fracture that's dislocated posteriorly and so we can kind of see that some of these folks can have various degrees of stability and this one's clearly a very unstable situation with compression of the cord in the hangman's fracture we can kind of see the the small lucency that's through the the ring of c2 and so there's various types of trauma extraction collection distraction extension extension extension compression um so we do see all of these and their management can be quite different there's a burst fracture which is an actual loading type fracture fracture dislocation which potentially is the worst where you've got these three columns of injury and you have to put all this back together um there's uh disrupted facets there is a perched facet that we can see in the middle um it's just about to go over in a lock facet and these can be tough to reduce we we try to reduce them uh often closed that is put the head and gardener wells tongues with various weight and tilt the head forward and pull that back up it's very disconcerting you feel this chunk um and usually under ideal situations try to do it when the patient's awake and can tell you hey uh i'm getting numb or something doesn't feel right um and but sometimes that doesn't lock and or it doesn't work and you have to go to your work at least to reduce it and then uh or to diffuse it there's a tear or tear drop fracture again another axial loading and inflection uh kind of injury lots of spinous process fractures so-called clay shovels uh injury we get multiple of these with a hyper uh extension type of injury ligamentous injuries that may not show up on ct um but certainly mri uh we can see that the posterior spinous uh interspinous ligaments are disrupted here hey everyone ryan rad here from neurosurgery training.org if you like that video subscribe and donate to keep our content available for medical students across the world