A man fell down from a height of 35 feet. Eyewitnesses say that he landed on his feet. Which of the following injury is possible?
Ans. d. Ring fracture of foramen magnum with lumbar spine injury (Ref: Ready 33/e p247; Parikh's 6/4.94-4.97)"Ring fracture: This term is commonly used to signify any fracture around the foramen magnum. Technically it means a fissured fracture about 3.5 cm outside the foramen magnum at the back, involving middle ear sideways and roof of nose anteriorly. It is rare and usually requires a lot of force to produce. It results from fall from a height on feet or buttocks, sudden violent turn of head on spine, severe blow on the vertex which drives the skull downwards on the vertebral column or heavy blow directed underneath the occiput or chin. "Ring or Foramen FracturesIt is fissured fracture, which encircles the skull in such a manner that the anterior third is separated at its junction with the middle and posterior third.But usually the term is applied to a fracture, which runs at about 3 to 5 cm outside the foramen magnum at the back and sides of the skull, and passes forwards through the middle ears and roof of the nose, due to which the skull is separated from the spine.They are rare and occur after falls from a height on to the feet or buttocks.QSkull-vault fractureType of fractureDescriptionDiastatic fracture(sutural fractures)* Separation of suturesQ* Occurs only in young persons due to blow with blunt weapon or from cerebral edemaQFissured fracture* A linear fracture or crack involving the outer or inner table or both.* Fracture only involving inner table cannot be detected on X-ray. It can be detected at autopsyDepressed fracture* Caused by a heavy weapon with a small striking surface e.g., hammer* Its shape may indicate the type of weapon with which it is produced. It is therefore called as signature fractureQ.Comminuted fracture* It has stellate appearance when there is no displacement of fragments.* Also called spider web fractureQPond fracture* Occurs in children due to elasticity of their bones* Also called indented fracturesQGutter fracture* When a part of thickness of bone is removed to form a gutter e.g., glancing oblique bullet woundsQElevated fracture* Result from a blow of moderately heavy sharp edge weapon e.g., axe which elevate one end of bone above the surface while other end may dip down to injured duraQRing fracture* Any fracture around the foramen magnumQ
Gutter fracture skull with cervical spine injury'
Pond fracture skull with cerv ical spine injury
Depressed fracture skull with cervical spine injury'
Ring fracture of foramen magnum with lumbar spine injury
Injuries