Thoracolumbar Fractures

Types of Fractures

• Simple compression fractures• Burst fractures• Flexion distraction fractures• Chance fractures• Fracture dislocations• Posterior fractures

Anatomy

• Anterior column- ant ½ of the disc and ALL• Middle Column- post ½ of disc and PLL• Posterior Column- facets, supra and

interspinous ligaments

Biomechanics (3 column theory)

• Anterior and middle column together (vertebral bodies) carry 70-80% of the total weight

• Facets carry the other 20-30%• Upper lumbar spine is at the transition of a

stiff segment (thoracic spine) and a mobile segment (lumbar spine)

Injury Mechanics

• Direct blow- normally will cause TP fractures- (asso with kidney contusions)

• Seat belt injury (without shoulder restraint) causes fulcrum anterior to spine so all three columns fail in tension (chance fracture)

• Direct fall onto buttocks causes axial compression- either compression or burst

• Direct fall onto buttocks with some flexion causes either simple compression or flexion distraction

• Fall onto buttocks with extension can cause facet or pars (spondylolysis) fracture

• Fracture dislocations asso with ejection from car

Simple Compression Fractures

• On X-Ray- only anterior column injury.• Less than 30% anterior column injury• Less than 10 degrees kyphosis• No splaying of spinous processes• No splaying of pedicles• No laminar fractures• Posterior body line intact

Examination

• Neuro exam includes motor, sensory, anal motor and sensation, superficial and deep reflexes, bulbocavernosis reflexes