Isolated transverse process fracture - Revision history

Rossdonaldson1: /* Evaluation */

2022-10-19T21:55:47Z

Evaluation

← Older revision		Revision as of 21:55, 19 October 2022
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	==Evaluation==		==Evaluation==
			[[File:PMC2776377 JETS-02-217-g001.png\|thumb\|Lumbar spine antero-posterior x-ray showing fractures of left L2 and L3 transverse processes (arrows).]]
	===Workup===		===Workup===
	*CT scan (gold standard)		*CT scan (gold standard)

Rossdonaldson1: Rossdonaldson1 moved page Isolated transverse process fractures to Isolated transverse process fracture

2020-10-24T13:54:48Z

Rossdonaldson1 moved page Isolated transverse process fractures to Isolated transverse process fracture

← Older revision	Revision as of 13:54, 24 October 2020
(No difference)

Rossdonaldson1: /* Differential Diagnosis */

2020-10-24T13:23:16Z

Differential Diagnosis

← Older revision		Revision as of 13:23, 24 October 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Blunt neck trauma DDX}}		{{Blunt neck trauma DDX}}
			{{Thoracic trauma DDX}}
			{{Lower back pain DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Differential Diagnosis */

2020-10-24T13:19:02Z

Differential Diagnosis

← Older revision		Revision as of 13:19, 24 October 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
			{{Blunt neck trauma DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1 at 13:13, 24 October 2020

2020-10-24T13:13:53Z

← Older revision		Revision as of 13:13, 24 October 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
	~~{{Cervical spine injuries}}~~

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Background */

2020-10-24T12:26:28Z

Background

← Older revision		Revision as of 12:26, 24 October 2020
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	*Are not associated with any ligamentous or structural injury that can contribute to spinal instability or spinal cord compromise.		*Are not associated with any ligamentous or structural injury that can contribute to spinal instability or spinal cord compromise.
	*Systematic literature review reveals 819 documented cases, with none requiring surgical intervention<ref>Schotanus M, van Middendorp JJ, Hosman AJ. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976). 2010; 35(19): E965-70.</ref><ref>Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008; 65(4): 832-6; discussion 6.</ref><ref>Homnick A, Lavery R, Nicastro O, Livingston DH, Hauser CJ. Isolated thoracolumbar transverse process fractures: call physical therapy, not spine. J Trauma. 2007; 63(6): 1292-5.</ref><ref>Akinpelu BJ, Zuckerman SL, Gannon SR, Westrick A, Shannon C, Naftel RP. Pediatric isolated thoracic and/or lumbar transverse and spinous process fractures. J Neurosurg Pediatr. 2016: 1-6.</ref>		*Systematic literature review reveals 819 documented cases, with none requiring surgical intervention<ref>Schotanus M, van Middendorp JJ, Hosman AJ. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976). 2010; 35(19): E965-70.</ref><ref>Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008; 65(4): 832-6; discussion 6.</ref><ref>Homnick A, Lavery R, Nicastro O, Livingston DH, Hauser CJ. Isolated thoracolumbar transverse process fractures: call physical therapy, not spine. J Trauma. 2007; 63(6): 1292-5.</ref><ref>Akinpelu BJ, Zuckerman SL, Gannon SR, Westrick A, Shannon C, Naftel RP. Pediatric isolated thoracic and/or lumbar transverse and spinous process fractures. J Neurosurg Pediatr. 2016: 1-6.</ref>

			{{Vertebral fractures and dislocations types}}

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Adults (>15 years old) */

2020-01-27T17:58:29Z

Adults (>15 years old)

← Older revision		Revision as of 17:58, 27 January 2020
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	**Immobilization via cervical collar, brace (e.g. TLSO), halo vest is '''not''' necessary		**Immobilization via cervical collar, brace (e.g. TLSO), halo vest is '''not''' necessary
	***May hinder patient recovery (e.g. inhibit pulmonary function, increase intracranial pressure, pressure sores, increased medical costs)		***May hinder patient recovery (e.g. inhibit pulmonary function, increase intracranial pressure, pressure sores, increased medical costs)
	*~~Subaxial cervical spine (C3-C7) without involvement of the transverse foramen, thoracic, or lumbar spine~~ do '''not''' require spine specialist consult (e.g. neurosurgery, orthopedics)<ref>Schotanus M, van Middendorp JJ, Hosman AJ. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976). 2010; 35(19): E965-70.</ref><ref>Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008; 65(4): 832-6; discussion 6.</ref>		*The following types do '''not''' require spine specialist consult (e.g. neurosurgery, orthopedics):<ref>Schotanus M, van Middendorp JJ, Hosman AJ. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976). 2010; 35(19): E965-70.</ref><ref>Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008; 65(4): 832-6; discussion 6.</ref>
	**Involvement of the transverse foramen may suggest a possible vertebral artery injury and should be pursued with further evaluation and spine specialty consult.		**Subaxial cervical spine (C3-C7) without involvement of the transverse foramen
			***Involvement of the transverse foramen may suggest a possible vertebral artery injury and should be pursued with further evaluation and spine specialty consult.
			**Thoracic (all)
			**Lumbar (all)

	===Pediatric Patients (<15 years old)===		===Pediatric Patients (<15 years old)===

Rossdonaldson1: /* Adults (>15 years old) */

2019-06-03T15:46:35Z

Adults (>15 years old)

← Older revision		Revision as of 15:46, 3 June 2019
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	**Immobilization via cervical collar, brace (e.g. TLSO), halo vest is '''not''' necessary		**Immobilization via cervical collar, brace (e.g. TLSO), halo vest is '''not''' necessary
	***May hinder patient recovery (e.g. inhibit pulmonary function, increase intracranial pressure, pressure sores, increased medical costs)		***May hinder patient recovery (e.g. inhibit pulmonary function, increase intracranial pressure, pressure sores, increased medical costs)
	*Subaxial cervical spine (C3-C7) without involvement of the transverse foramen, thoracic, or lumbar spine do '''not''' require spine specialist (e.g. neurosurgery, orthopedics) ~~consultation~~<ref>Schotanus M, van Middendorp JJ, Hosman AJ. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976). 2010; 35(19): E965-70.</ref><ref>Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008; 65(4): 832-6; discussion 6.</ref>		*Subaxial cervical spine (C3-C7) without involvement of the transverse foramen, thoracic, or lumbar spine do '''not''' require spine specialist consult (e.g. neurosurgery, orthopedics)<ref>Schotanus M, van Middendorp JJ, Hosman AJ. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976). 2010; 35(19): E965-70.</ref><ref>Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008; 65(4): 832-6; discussion 6.</ref>
	**Involvement of the transverse foramen may suggest a possible vertebral artery injury and should be pursued with further evaluation and spine specialty consult.		**Involvement of the transverse foramen may suggest a possible vertebral artery injury and should be pursued with further evaluation and spine specialty consult.

Rossdonaldson1: /* Adults (>15 years old) */

2019-06-03T15:46:03Z

Adults (>15 years old)

← Older revision		Revision as of 15:46, 3 June 2019
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	**Immobilization via cervical collar, brace (e.g. TLSO), halo vest is '''not''' necessary		**Immobilization via cervical collar, brace (e.g. TLSO), halo vest is '''not''' necessary
	***May hinder patient recovery (e.g. inhibit pulmonary function, increase intracranial pressure, pressure sores, increased medical costs)		***May hinder patient recovery (e.g. inhibit pulmonary function, increase intracranial pressure, pressure sores, increased medical costs)
	~~nor~~
	*Subaxial cervical spine (C3-C7) without involvement of the transverse foramen, thoracic, or lumbar spine do '''not''' require spine specialist (e.g. neurosurgery, orthopedics) consultation<ref>Schotanus M, van Middendorp JJ, Hosman AJ. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976). 2010; 35(19): E965-70.</ref><ref>Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008; 65(4): 832-6; discussion 6.</ref>		*Subaxial cervical spine (C3-C7) without involvement of the transverse foramen, thoracic, or lumbar spine do '''not''' require spine specialist (e.g. neurosurgery, orthopedics) consultation<ref>Schotanus M, van Middendorp JJ, Hosman AJ. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976). 2010; 35(19): E965-70.</ref><ref>Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008; 65(4): 832-6; discussion 6.</ref>
	**Involvement of the transverse foramen may suggest a possible vertebral artery injury and should be pursued with further evaluation and spine specialty consult.		**Involvement of the transverse foramen may suggest a possible vertebral artery injury and should be pursued with further evaluation and spine specialty consult.

Rossdonaldson1: /* Adults (>15 years old) */

2019-06-03T15:45:50Z

Adults (>15 years old)

← Older revision		Revision as of 15:45, 3 June 2019
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	*Pain management, early mobilization, and unrestricted movement		*Pain management, early mobilization, and unrestricted movement
	**Do '''not''' require surgical intervention		**Do '''not''' require surgical intervention
	**Immobilization via cervical collar, brace (e.g. TLSO), halo vest is not necessary		**Immobilization via cervical collar, brace (e.g. TLSO), halo vest is '''not''' necessary
	***May hinder patient recovery (e.g. inhibit pulmonary function, increase intracranial pressure, pressure sores, increased medical costs)		***May hinder patient recovery (e.g. inhibit pulmonary function, increase intracranial pressure, pressure sores, increased medical costs)
	nor		nor
	*Subaxial cervical spine (C3-C7) without involvement of the transverse foramen, thoracic, or lumbar spine do '''not''' require spine specialist (e.g. neurosurgery, orthopedics) consultation<ref>Schotanus M, van Middendorp JJ, Hosman AJ. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976). 2010; 35(19): E965-70.</ref><ref>Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008; 65(4): 832-6; discussion 6.</ref>		*Subaxial cervical spine (C3-C7) without involvement of the transverse foramen, thoracic, or lumbar spine do '''not''' require spine specialist (e.g. neurosurgery, orthopedics) consultation<ref>Schotanus M, van Middendorp JJ, Hosman AJ. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population. Spine (Phila Pa 1976). 2010; 35(19): E965-70.</ref><ref>Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008; 65(4): 832-6; discussion 6.</ref>
	**Involvement of the transverse foramen may suggest a possible vertebral artery injury and should be pursued with further evaluation and spine specialty consult.		**Involvement of the transverse foramen may suggest a possible vertebral artery injury and should be pursued with further evaluation and spine specialty consult.

	===Pediatric Patients (<15 years old)===		===Pediatric Patients (<15 years old)===