Mechanism Extension and Rotation

PILLAR FRACTURE Extension and rotation can cause impaction of a superior vertebra on the articular mass of its inferior neighbor. The resultant vertical or oblique fracture of the articular mass is called a pillar fracture (Fig.264-10). The adjacent lamina and pedicle remain intact. The lateral view may show a "double-outline" sign at the level of the injury. This can be differentiated from the normal lateral radiograph, in which the articular masses are imposed on one another and only a single radiographic density is seen. The double outline occurs when the fractured articular mass is displaced posteriorly and causes two radiographic shadows. The AP projection will show an abnormality of the lateral column and a fracture at the level of the injury. The fracture is considered stable. Immediate specialist consultation is indicated.16

FRACTURE SEPARATION Harris has described the fracture/separation as a pedicolaminar fracture because it involves fractures of the pedicle and lamina. There are varying degrees of fracture, ranging from fractures without displacement to disruption of the anterior longitudinal ligament and disk rupture. The lateral radiograph may show rotation of the involved articular mass as compared with the uninvolved lateral mass at the level of the injury. Anterior listhesis may be seen in more severe mechanisms. The AP view may show disruption of the lateral column. Immediate consultation is recommended.

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