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Transverse Process Fracture

Fractured Transverse Process

Transverse process fracture is a rare and stable fracture of the spine. It occurs as a result of sudden and extreme trauma. Although the fracture is not associated with spinal cord damage and neurological deficits, the extreme force of the injury can cause visceral injuries and internal hemorrhage. Diagnosis of a transverse process fracture is based on computed tomography.


Presentation

Transverse process is a bony protrusion from the posterior aspect of the vertebra. Every cervical, thoracic and lumbar vertebra has a transverse process on either side. Although transverse process fractures (TPF) are considered minor spinal injuries, they occur as a result of major force and are often related to other serious injuries. Cervical transverse process fractures frequently appear in the context of other cervical spine fractures [1], vertebral artery dissection and blunt cerebrovascular injury (BCVI) while 35% patients with lumbar transverse process fractures have intraabdominal (hepatic, splenic, genitourinary and diaphragmatic) injuries [2]. Lumbar TPF are more common, involve the upper lumbar spine and are usually multiple [1]. They can occur as a result of blunt trauma e.g during motor vehicle accidents; violent lateral flexion-extension injuries e.g. during football or other sports; avulsion injury of the psoas muscle; or Malgaigne fractures of the pelvis.[3] [4] [5]. Although TPF have been reported to be associated with visceral injuries [2] [4], they can also occur in the absence of other vertebral and visceral injuries [6].

Patients usually present with sudden onset of severe pain following the injury with decreased range of motion in the region of the affected part of the spine. The pain may be aggravated with movement and there may be swelling and tenderness around the fracture site. If there are visceral injuries, patients may present with features of hypovolemic shock. Patients with isolated transverse process fractures do not present with neurological deficits.

Internal Bleeding
  • That being said, transverse process fractures can cause internal bleeding, so you should contact a back specialist immediately if you experience any of the following symptoms: Increasing spine or abdominal pain Dizziness, weakness or fainting Blood or[sinicropispine.com]
  • However, the forces that cause this fracture can also cause internal bleeding or other injuries that might not be clear at the time of your first exam. Be sure to watch for the symptoms listed under "When to seek medical advice."[fairview.org]
Fever
  • ROS: CONSTITUTIONAL: No fevers, chills or weakness. EYES: No visual changes. ENT: No facial trauma. CARDIOVASCULAR: Some left-sided upper back, chest pain. RESPIRATORY: Some pain with deep breaths on the left. No shortness of breath.[drhem.wordpress.com]
Left Flank Pain
  • He drove himself here to the hospital and currently is standing at the side of the bed complaining of pain in the left lower back, left elbow, and left flank pain. The pain in the back has not radiated.[drhem.wordpress.com]
Scleral Icterus
  • No scleral icterus. ENT: His oropharynx is clear with moist mucous membranes. NECK: Trachea is midline, no tenderness in the cervical spine to palpation CARDIOVASCULAR: Heart has a regular rate and rhythm. There is no S3, S4.[drhem.wordpress.com]
Back Pain
  • Postural causes of low back pain Scoliosis - this is an S shape deformity in the spine. Hyperlordosis - is an exaggerated lumber curve in the spine.[sportsinjuryclinic.net]
  • If you are suffering from back pain as the result of an injury or accident, call Dr. Chetan Patel at the Spine Health Institute. He can get you back in the game in no time.[thespinehealthinstitute.com]
  • However, he was complaining of low back pain, non-radiating and minimal relief with analgesics. An MRI of the dorso-lumbar spine was performed and it was normal.[joas.in]
  • pain that spreads to one or both legs 2000-2018 The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067.[fairview.org]
  • The Veritas Health platform comprising of Spine-health.com , Arthritis-health.com , Sports-health.com , and Pain-health.com , provides comprehensive information on back pain, arthritis, sports injuries, and chronic pain conditions.[spine-health.com]
Low Back Pain
  • However, he was complaining of low back pain, non-radiating and minimal relief with analgesics. An MRI of the dorso-lumbar spine was performed and it was normal.[joas.in]
  • Postural causes of low back pain Scoliosis - this is an S shape deformity in the spine. Hyperlordosis - is an exaggerated lumber curve in the spine.[sportsinjuryclinic.net]
  • Mechanical Low Back Pain ( Non-Specific Low Back Pain) Any type of back pain in the lumbar region that is not related to serious pathology or does not have a specific cause.[physio-pedia.com]
Elbow Pain
  • Left elbow pain. NEUROLOGIC: No loss of consciousness, numbness, tingling or weakness. PAST MEDICAL HISTORY: None. PAST SURGICAL HISTORY: Vasectomy MEDICATIONS: NONE ALLERGIES: None. SOCIAL HISTORY: Denies alcohol, tobacco, and illicit drug abuse.[drhem.wordpress.com]
Microscopic Hematuria
  • This is to assess for microscopic hematuria or gross hematuria. There is controversy related to the evaluation of ureteral injuries, by means of urinalysis. Hematuria is found in 74% of cases (either gross or microscopic.)[drhem.wordpress.com]
Flank Pain
  • He drove himself here to the hospital and currently is standing at the side of the bed complaining of pain in the left lower back, left elbow, and left flank pain. The pain in the back has not radiated.[drhem.wordpress.com]

Workup

Transverse process fractures are known to occur after high-velocity trauma and therefore all patients must be evaluated thoroughly for the presence of serious visceral injuries [3] [4] [7]. After eliciting the history of the type of injury, the physician should examine the cervical, thoracic and lumbar spine and abdominopelvic region followed by a detailed neurological evaluation. Laboratory tests are not helpful in diagnosis but can help to evaluate comorbid medical conditions. So complete blood count, blood sugar, serum chemistries, blood grouping, cross matching and urinalysis depending on the clinical presentation should be ordered. Urinalysis can help to identify renal injury while elevated amylase levels may be an indication of pancreatic injury and elevated cardiac markers can indicate cardiac contusion.

Conventional radiographs are not very helpful as they are frequently unable to detect TPF and concomitant visceral injuries in the emergency setting in the presence of bowel gas [1] [3] [8]. Computed tomography is, therefore, the investigation of choice as it can identify TPF successfully, as well as related visceral injuries [1] [4] [9]. Magnetic resonance imaging may be required if spinal cord trauma is suspected.

Treatment

  • This report introduces a method of active treatment to help patients with LSTPFs quickly return to their daily lives and professional activities.[ncbi.nlm.nih.gov]
  • Treatment progresses as pain subsides, meaning you can begin to take on more activity as discomfort fades.[sinicropispine.com]
  • Confidently approach every form of traumatic injury with current coverage of relevant anatomy and biomechanics, mechanisms of injury, diagnostic approaches, treatment options, and associated complications.[books.google.com]
  • Traction is often helpful for patients with a disc herniation, although in some cases the initial pain relief was followed by an increase in pain after treatment.[sportsinjuryclinic.net]
  • In one cohesive source, the book brings together information on state-of-the-art clinical imaging—including multidetector CT and high-field MRI techniques—and the pathophysiology, neurologic evaluation, medical management, surgical treatment, and postoperative[books.google.com]

Etiology

  • Etiology blunt trauma lateral flexion-extension injury psoas muscle avulsion Malgaigne pelvic fracture Associations Although a minor injury to the lumbar spine, transverse process fractures require major force: cervical transverse process fractures have[radiopaedia.org]
  • Etiology: In general, compared with adults, pediatric patients have greater ligamentous flexibility and elasticity, shallower and more horizontal facets, and relative paraspinal muscle immaturity.[posna.org]
  • Epidemiology /Etiology “In 2005, osteoporosis was responsible for more than 2 million fractures; approximately 547,000 of those were vertebral fractures.[physio-pedia.com]

Epidemiology

  • Epidemiology: Fractures of the thoracolumbar spine account for 1% to 2% of all pediatric fractures. The most common cause of pediatric spine trauma is motor vehicle accidents (even when seat belts are used), which lead to 33% to 58% of all injuries.[posna.org]
  • Epidemiology /Etiology “In 2005, osteoporosis was responsible for more than 2 million fractures; approximately 547,000 of those were vertebral fractures.[physio-pedia.com]
Sex distribution
Age distribution

Pathophysiology

  • In one cohesive source, the book brings together information on state-of-the-art clinical imaging—including multidetector CT and high-field MRI techniques—and the pathophysiology, neurologic evaluation, medical management, surgical treatment, and postoperative[books.google.com]
  • ., Pathophysiology, diagnosis, and treatment of discogenic low back pain, World J Orthop 2013 April 18; 4(2): 42-52 (LoE: 5) Davis JM, Beall DP, Lastine C, Sweet C, Wolff J, Wu D. Chance fracture of the upper thoracic spine.[physio-pedia.com]

Prevention

  • A brace may be used to help protect the injured area and prevent any bending, twisting and lifting movements.[thespinehealthinstitute.com]
  • So much so that increasing strength not only relieves pain and symptoms from those patients with fractures, but also can act as a preventative to decrease future fractures.[physio-pedia.com]
  • ATLS protocols should be maintained during initial assessment using pediatric spine board to elevate the child’s torso preventing neck hyperflexion when necessary. This is particularly important if children are less than 6 years.[posna.org]

References

Article

  1. Green NE, Swiontkowski MF. Skeletal Trauma in Children: Expert Consult - Print and Online, 4e. Saunders; 2003.
  2. Patten RM, Gunberg SR, Brandenburger DK. Frequency and importance of transverse process fractures in the lumbar vertebrae at helical abdominal CT in patients with trauma. Radiology. 2000;215 (3):831-834.
  3. Miller CD, Blyth P, Civil ID. Lumbar transverse process fractures: A sentinel marker of abdominal organ injuries. Injury. 2000;31:773–776.
  4. Krueger MA, Green DA, Hoyt D, Garfin SR. Overlooked spine injuries associated with lumbar transverse process fractures. Clin Orthop Relat Res. 1996;327:191–195.
  5. Brynin R, Gardiner L. Missed lumbar transverse process fractures in a high school football player. J Manipulative Physiol Ther. 2001;24:123–126.
  6. Epstein BS. The spine: A radiological text and atlas. 4th ed. Philadelphia: Lea and Febiger; 1976. p. 572.
  7. Daglar B, Bayrakçi K, Tasbas BA, et al. Importance of lumbar vertebra transverse process fractures in multitrauma patients who had undergone emergent laparotomy. Ulus Travma Acil Cerrahi Derg. 2005;11:58–63.
  8. Gestring ML, Gracias VH, Feliciano MA, et al. Evaluation of the lower spine after blunt trauma using abdominal computed tomographic scanning supplemented with lateral scanograms. J Trauma. 2002;53:9–14.
  9. Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. J Trauma. 2008;65:832–836.

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Last updated: 2018-06-21 20:37