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International Journal of Clinical & Medical Images

ISSN: 2376-0249

Clinical Image - International Journal of Clinical & Medical Images (2014) Volume 1, Issue 2

Atypical Fracture Dislocation of Thoracic Vertebra in a Young Men

Atypical Fracture Dislocation of Thoracic Vertebra in a Young Men

Author(s): David Ruiz Picazo, Jos Ramrez Villaescusa and Mara 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) [4] 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) [5] 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) [6]. This is an unusual lesion that can be described as dislocation-enucleation of thoracic vertebral body.

References

Magerl F1, Aebi M, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3: 184-201. Vaccaro AR1, Zeiller SC, Hulbert RJ, Anderson PA, Harris M, et al. (2005) The thoracolumbar injury severity score: a proposed treatment algorithm. J Spinal Disord Tech 18: 209-215. Vaccaro AR1, Oner C, Kepler CK, Dvorak M, Schnake K, et al. (2013) AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976) 38: 2028-2037. Vaccaro AR1, Lim MR, Hurlbert RJ, Lehman RA Jr, Harrop J, et al. (2006) Surgical decision making for unstable thoracolumbar spine injuries: results of a consensus panel review by the Spine Trauma Study Group. J Spinal Disord Tech 19: 1-10. Vaccaro AR1, Lee JY, Schweitzer KM Jr, Lim MR, Baron EM, et al. (2006) Assessment of injury to the posterior ligamentous complex in thoracolumbar spine trauma. Spine J 6: 524-528. Pizones J1, Izquierdo E, Sánchez-Mariscal F, Zúñiga L, Álvarez P, et al. (2012) Sequential damage assessment of the different components of the posterior ligamentous complex after magnetic resonance imaging interpretation: prospective study 74 traumatic fractures. Spine (Phila Pa 1976) 37: E662-667.

Corresponding author


David Ruiz Picazo

Spine Unit

Department of Orthopedic Surgery

Spain 

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