Thoracic and lumbar fractures and dislocations: Difference between revisions
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==Classification== | ==Classification== | ||
* Wedge compression fracture | * Wedge compression fracture | ||
* 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 >30o | *** Kyphosis >30o | ||
* Rotational component to the injury | *** Rotational component to the injury | ||
* Compression fx at multiple sites | *** Compression fx at multiple sites | ||
* Posterior cortex abnormality | *** Posterior cortex abnormality | ||
* Burst fracture | * Burst fracture | ||
* Unstable | ** Unstable | ||
* Can occur with or without injury to posterior elements (posterior involvement increases risk for neuro deficits) | ** Can occur with or without injury to posterior elements (posterior involvement increases risk for neuro deficits) | ||
* Be certain not to mistakenly call a burst fracture a wedge fracture | ** Be certain not to mistakenly call a burst fracture a wedge fracture | ||
* Obtain CT if unsure | *** Obtain CT if unsure | ||
* Flexion-distraction Injuries (lap belt) | * Flexion-distraction Injuries (lap belt) | ||
* Obtain sagittally reconstructed CT if suspect lap-belt mechanism or flexion-distraction | ** Obtain sagittally reconstructed CT if suspect lap-belt mechanism or flexion-distraction | ||
* Unstable | ** Unstable | ||
* Intra-abdominal injuries more commonly associated than neuro deficits | ** Intra-abdominal injuries more commonly associated than neuro deficits | ||
* Chance Fx | ** Chance Fx | ||
* Lap belt worn above the pelvic bones without a shoulder harness | *** Lap belt worn above the pelvic bones without a shoulder harness | ||
* Forceful flexion at the lap belt > compressive failure of the ant and middle columns | **** Forceful flexion at the lap belt > compressive failure of the ant and middle columns | ||
* One or both articular processes fx > upper vertebrae anteriorly dislocates | ***** One or both articular processes fx > upper vertebrae anteriorly dislocates | ||
* Imaging | ** Imaging | ||
* Compression fx + increased posterior interspinous spaces caused by distraction | *** Compression fx + increased posterior interspinous spaces caused by distraction | ||
* 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 | ||
==Source== | ==Source== | ||
UpToDate | UpToDate | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Revision as of 03:06, 3 March 2011
Pearls
- 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:
- >30o for compression fx
- > 25o for burst fx
- Neurologic deficit
Classification
- Wedge compression fracture
- 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 >30o
- Rotational component to the injury
- Compression fx at multiple sites
- Posterior cortex abnormality
- Burst fracture
- Unstable
- Can occur with or without injury to posterior elements (posterior involvement increases risk for neuro deficits)
- Be certain not to mistakenly call a burst fracture a wedge fracture
- Obtain CT if unsure
- Flexion-distraction Injuries (lap belt)
- Obtain sagittally reconstructed CT if suspect lap-belt mechanism or flexion-distraction
- Unstable
- Intra-abdominal injuries more commonly associated than neuro deficits
- Chance Fx
- Lap belt worn above the pelvic bones without a shoulder harness
- Forceful flexion at the lap belt > compressive failure of the ant and middle columns
- One or both articular processes fx > upper vertebrae anteriorly dislocates
- Forceful flexion at the lap belt > compressive failure of the ant and middle columns
- Lap belt worn above the pelvic bones without a shoulder harness
- Imaging
- Compression fx + increased posterior interspinous spaces caused by distraction
- Translational
- Massive direct trauma to the back > failure of all 3 columns
- Almost invariably demonstrate neuro deficits
Source
UpToDate