Thoracic and lumbar fractures and dislocations: Difference between revisions

(Text replacement - "fx " to "fracture ")
(Text replacement - "* " to "*")
Line 15: Line 15:
==Classification==
==Classification==
===Compression (wedge)===
===Compression (wedge)===
* Only unstable if posterior ligament complex ruptures (requires a rotational force)
*Only unstable if posterior ligament complex ruptures (requires a rotational force)
* Suspect instability and obtain CT if:
*Suspect instability and obtain CT if:
** Severe compression (>50% loss of vertebral height)
**Severe compression (>50% loss of vertebral height)
** Kyphosis >30deg
**Kyphosis >30deg
** Rotational component to injury
**Rotational component to injury
** Compression fracture at multiple sites
**Compression fracture at multiple sites
** Posterior cortex abnormality
**Posterior cortex abnormality


===[[Thoracic burst fracture]]===
===[[Thoracic burst fracture]]===
Line 35: Line 35:
*Unstable
*Unstable
*Seat Belt Injury: lap belt worn above the pelvic bones without a shoulder harness
*Seat Belt Injury: lap belt worn above the pelvic bones without a shoulder harness
** Forceful flexion at lap belt leads to compression fracture of ant and middle columns  
**Forceful flexion at lap belt leads to compression fracture of ant and middle columns  
**Associated with intra-abdominal injury (rectus sheath hematoma, intestinal perforation)
**Associated with intra-abdominal injury (rectus sheath hematoma, intestinal perforation)
***One or both articular processes fracture > upper vertebrae anterior dislocates/subluxation
***One or both articular processes fracture > upper vertebrae anterior dislocates/subluxation
Line 50: Line 50:


===Translational===
===Translational===
* Massive direct trauma to the back > failure of all 3 columns
*Massive direct trauma to the back > failure of all 3 columns
* Almost invariably demonstrate neuro deficits
*Almost invariably demonstrate neuro deficits


==Differential Diagnosis==
==Differential Diagnosis==

Revision as of 22:03, 6 July 2016

Background

  • Injury to thoracic spine necessitates severe force
    • When spinal cord injury occurs usually complete
  • Stable if two or more of the spinal columns are intact:
    • Anterior (anterior longitudinal ligament, annulus fibrosus, ant. half of the vertebral body)
    • Middle (posterior longitudinal ligament, posterior annulus fibrous, and post. half of vertebral body
    • Posterior (supraspinous and interspinous ligaments, facet joint capsule)
  • Unstable if:
    • 50% loss of vertebral height
    • Kyphotic angulation around the fx:
      • >30' for compression fx
      • > 25' for burst fracture
    • Neurologic deficit

Classification

Compression (wedge)

  • Only unstable if posterior ligament complex ruptures (requires a rotational force)
  • Suspect instability and obtain CT if:
    • Severe compression (>50% loss of vertebral height)
    • Kyphosis >30deg
    • Rotational component to injury
    • Compression fracture at multiple sites
    • Posterior cortex abnormality

Thoracic burst fracture

Lumbar burst fracture

Flexion-Distraction Injuries (lap belt)

  • Unstable
  • Intra-abdominal injuries more commonly associated than neuro deficits
  • Obtain sagittally reconstructed CT if suspect lap-belt mechanism or flexion-distraction

Chance Fracture

  • most common at T12-L2 due to spinal curvature and mechanism
  • Unstable
  • Seat Belt Injury: lap belt worn above the pelvic bones without a shoulder harness
    • Forceful flexion at lap belt leads to compression fracture of ant and middle columns
    • Associated with intra-abdominal injury (rectus sheath hematoma, intestinal perforation)
      • One or both articular processes fracture > upper vertebrae anterior dislocates/subluxation
  • Imaging
    • anterior vertebral body compression fracture with extension through middle of vertebral body into posterior wall
    • Compression fracture + increased posterior interspinous spaces caused by distraction
  • Management
    • type and screen/cross, labs including pancreatic enzymes if thoraco-lumbar location
    • consult ortho or neurosurgery (institution dependent)
    • spinal precautions
    • emergency operative repair unless medically unstable

Translational

  • Massive direct trauma to the back > failure of all 3 columns
  • Almost invariably demonstrate neuro deficits

Differential Diagnosis

Lower Back Pain

Management

LUMBAR

  • Stable Fractures - TLSO brace as directed by Neurosurg


CT IF:

  • Compression
  • Wedge
  • >50% height (r/o middle column & burst)

See Also

References

Retrieved from "https://www.wikem.org/w/index.php?title=Thoracic_and_lumbar_fractures_and_dislocations&oldid=81812"