Clinical Image - International Journal of Clinical & Medical Images (2014) Volume 1, Issue 2
Author(s): David Ruiz Picazo, José Ramírez Villaescusa and María Dolores Monedero Picazo
We present the case of a 16 years old male patient who had a motor vehicle accident that required admission to intensive care unit. He suffered severe TBI (Glasgow 3) with severe chest trauma and fractures in the lower limbs (diaphyseal fracture of the right femur and open fracture Gustilo IIIA of left tibia). Total body CT was performed and high thoracic spine injury was seen. Coronal fracture of the posterior vertebral body of T6, T5 vertebral body fracture dislocation with subtotal enucleation, a suitable coronal alignment and regional thoracic kyphosis. Such findings were consistent with fracture dislocation type C without reliable evidence of damage of posterior ligamentous complex (PLC) (Figure 1,2 and 3) Transcranial magnetic stimulation was performed confirming complete injury of corticospinal tract. Surgical treatment by right transthoracic anterior approach, decompression and stabilization with tricortical autogenous bone and plate was performed 48 hours later (Figure 4). The patient had no neurological improvement (ASIA A) There remains controversy which is the best classification system [1,2,3], the time of surgery, the type of approach (anterior, posterior or combined)  or the stabilization type (short vs long fusion). Although the morphological pattern is likely type C pattern (Magerl and AO Classification) [1,3], the injury shows dislocation of right T4 costovetebral joint, there is no clear evidence of injury PLC (just minimal increase in interspinous distance)  without rotational or translational component in coronal and sagittal plane, no dislocation of facet joints in the upper and lower vertebra with dislocation-enucleation of the T5 vertebral body. In the presence of neurological injury without MR, CT findings may be as useful as MR to assess levels and injury pattern to decide the best treatment (MR may not be necessary) . This is an unusual lesion that can be described as dislocation-enucleation of thoracic vertebral body.
Department of Orthopedic Surgery
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