Classification of Thoracic Fractures

Four major categories of thoracic fractures have been identified: compression fractures, burst fractures, seatbelt-type injuries and fracture dislocations. Denis advocated that the differences in how the middle column was affected determined what type of fracture would be produced [28].

Compression Fractures

These are the most frequently seen fractures in the thoracic spine and they usually occur as a result of an axial compression load. No pattern of spinal cord injury has been documented with this type of fracture. Radiographically, a reduction in height of the anterior portion of the vertebral body with no involvement of the posterior vertebral body is noticed. Kyphotic angulation and widening of the interspinous processes may be seen (Fig. 22.7). This is generally a stable type of injury, since there is no involvement of the middle column. If, however, the anterior body fracture reduces the height by at least 50%, there is the possibility of posterior column failure [29]. In this case, the middle column acts as a hinge, which results in a tension force on the posterior ligamentous structures. A long-term increase in deformity can be seen when there is associated kyphosis of greater than 30° or the patient has undergone a prior laminectomy. This places the spinal cord and roots at risk and, hence, many surgeons recommend a stabilization procedure to prevent progressive kyphosis. A universal segmental fixation system or the Harrington distraction rod system can correct the deformity and resist the failure associated with the axial loading.

Fig. 22.7. Illustration of anterior column compression fracture showing a reduction in height of the anterior portion of the vertebral body with no involvement of the posterior vertebral body. Kyphotic angulation occurs and widening of the interspinous processes may be seen. In these fractures, the middle column acts as a hinge, which results in a tension force on the posterior ligamentous structures.

Fig. 22.7. Illustration of anterior column compression fracture showing a reduction in height of the anterior portion of the vertebral body with no involvement of the posterior vertebral body. Kyphotic angulation occurs and widening of the interspinous processes may be seen. In these fractures, the middle column acts as a hinge, which results in a tension force on the posterior ligamentous structures.

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