Isolated transverse process fracture: Difference between revisions
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==Background== | ==Background== | ||
*Isolated transverse process fractures (iTPF) are defined as those involving the transverse process only, '''without''' extension into the pedicle, lamina, or facet complex. | |||
*Isolated transverse process fractures 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> | |||
==Clinical Features== | ==Clinical Features== | ||
*Pain over spine | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
===Workup=== | |||
*CT scan is the diagnostic gold standard imaging modality for suspected spine fractures | |||
*Consider additional trauma workup, as transverse process fractures may be indicators of other more serious injuries | |||
===Evaluation=== | |||
*Diagnosed typically on CT | |||
==Management== | ==Management== | ||
''Guidelines of management (including multiple isolated transverse process fractures), but not including any other injury)'' | |||
===Adults (>15 years old)=== | |||
*Pain management, early mobilization, and unrestricted movement | |||
**Do '''not''' require surgical intervention | |||
**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) | |||
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> | |||
**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)=== | |||
*Same as for adults, except only thoracolumbar spine fractures do '''not''' require spine specialist (e.g. neurosurgery, orthopedics) consultation<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> | |||
==Disposition== | ==Disposition== | ||
*Outpatient care | |||
==See Also== | ==See Also== | ||
Revision as of 15:38, 3 June 2019
Background
- Isolated transverse process fractures (iTPF) are defined as those involving the transverse process only, without extension into the pedicle, lamina, or facet complex.
- Isolated transverse process fractures 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[1][2][3][4]
Clinical Features
- Pain over spine
Differential Diagnosis
Evaluation
Workup
- CT scan is the diagnostic gold standard imaging modality for suspected spine fractures
- Consider additional trauma workup, as transverse process fractures may be indicators of other more serious injuries
Evaluation
- Diagnosed typically on CT
Management
Guidelines of management (including multiple isolated transverse process fractures), but not including any other injury)
Adults (>15 years old)
- Pain management, early mobilization, and unrestricted movement
- Do not require surgical intervention
- 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)
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[5][6]
- 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)
- Same as for adults, except only thoracolumbar spine fractures do not require spine specialist (e.g. neurosurgery, orthopedics) consultation[7]
Disposition
- Outpatient care
See Also
External Links
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.