Coronoid process apex fracture is the most common coronoid process fracture. It is fully included in the temporal muscle tendon and the bone fragments are infrequently displaced, whereas the other two types of coronoid process fracture are submuscular fractures and therefore are more susceptible to induce a displacement of bone fragments [27].
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The goals of treatment of unilateral facet fracture and fracture-dislocations are primarily preservation of the functional and anatomical continuity of the spinal cord and nerve roots, restoration of spinal canal alignment to relieve neural compression, establishment of spinal stability to provide freedom from postiinjury pain or delayed neurological problems and, finally, quick restoration of the highest functional level consistent with the patient's neurologic complication.5 In the literature, there are controversies concerning the treatment of unilateral facet fractures. If there is coexisting subluxation, cervical spine traction and reduction are tried. Open reduction is considered when closed reduction proves to be insufficient or when early decompression is required due to neurological deterioration. For postreduction immobilization, halo thoracic devices and internal fixation are the two choices.4, 5 The nonoperative treatment of unilateral facet fractures without subluxation is immobilization with halo-vest or hard-collar. Several series of cervical spine fractures immobilized in a halo vest have documented a high failure rate of facet fractures with subluxation. One problem with halo immobilization is the movement of the cervical spine, a snake-like movement of the middle and lower cervical vertebrae that occurs even with a properly placed halo-vest.2, 3, 4, 6, 13, 14 In Rorabeck et al's13 series of 26 patients, spontaneous fusion rate of the unilateral facet fractures following nonoperative treatment was only 20% and they stated that chronic cervical pain might occur because of late dislocations. In a series of 36 patients by Beyer and Cabanela, 24 patients were treated nonoperatively and the spontaneous fusion rate was reported as 50%. In the operatively treated 10 patients (wiring by posterior approach and fusion), they reported that residual subluxations or angulations were not seen at late period and suffering from pain was less than nonoperatively treated group.5 In the series by Lifeso et al,4 none of the six patients treated by halo-vest and 12 patients treated with hard-collar had success. Buchoz and Cheung suggested that patients with unilateral facet fractures with perched facets should be surgically stabilized rather than a trial of halo-vest immobilization. However, this does not address the issue of those patients who do not initially have subluxation and who subsequently sublux despite a cervical orthosis.3 Halliday et al evaluated ALL, PLL, interspinous ligaments and facet capsules with MRI during the acute period and recommended early surgical treatment in patients with injury at least in three of these structures.2 Surgery in the early period for these patients will prevent the chronic cervical pain or radicular pain that might develop via complications such as kyphosis, rotation and subluxation.2, 3, 13 As MRI can also successfully demonstrate cervical disc herniations, it is useful for the selection of surgical procedure, anterior or posterior approach.2, 4, 15, 16
I was stunned on how the plot of Fractured was weaved together to form an impressive psychological thriller movie. Sam Worthington as the lead - Ray Monroe was so effective that I cannot help but feel sympathy to his character. The narration of the story is gripping to watch until the end while its mystery theme made it a worthy movie to watch and to be recommended to others. Though the pacing of flashbacks at time is a little confusing but I think it is bearable to watch as it was fully explained by the story of Fractured. This film's premise has resemblance to my favorite mystery thriller movies like Flightplan (2005) and Unknown (2011) but with its own theme and style, Fractured stands on its own.
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