Mechanism of Injury and Classification

McAfee et al.26 have classified TLS injuries into major and minor fractures (T.a.b!e 2ยง4-4). A discussion of the classification follows. Wedge compression fractures are the result of flexion causing compression of the anterior body of the vertebra. Plain radiographs demonstrate loss of anterior height in the traumatized vertebra. The posterior height and cortex are intact. CT scanning should be performed to define the stability of the posterior elements and sparing of the neural canal. These fractures are not usually associated with neurologic compromise but should be treated as unstable until evaluation is complete. A flexion mechanism causing anterior vertebral compression with involvement of the posterior cortex defines the burst fracture. Lateral plain radiography will show the loss of anterior and posterior height; AP views will show and increase in the interpedicular distance; and a CT scan will define the extent of the injury. The burst fracture should be considered unstable. A Chance fracture is caused by a flexion around an axis anterior to the anterior spinal longitudinal ligament. A high-speed motor vehicle accident with the occupant in a lap belt will produce this mechanism. The Chance fracture involves the spinous process, lamina, transverse processes, pedicles, and vertebral body. 27 The lateral radiograph will show the fracture through the posterior elements and vertebral body. A CT scan may help to define the injury but can miss it if the fracture is in the same plane as the scan. The Chance fracture should be considered unstable.

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