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Burst Fracture

 

         Burst fractures result from axial loading most often secondary to motor vehicle accidents and falls

         The axial load drives the intervertebral disk into vertebral body below

         Usually produces a comminuted, vertical fracture through the vertebral body

         Fragments may be retropulsed into the spinal canal injuring the cord

         Burst fractures may resemble flexion-teardrop fractures

o       In a classical flexion-teardrop fracture, there is an avulsed anterior, inferior triangular bony fragment that is separated from the body and displaced anteriorly

o       Both the anterior and posterior ligamentous structures are injured, which may not be the case in a burst fracture

         Burst fractures, however, can have associated injury to the posterior ligamentous structures, especially if there is a combination of axial loading and flexion at the time of injury

         Clinically

o       Neck pain

o       Numbness or parasthesia

o       Weakness

         Imaging on conventional radiography

o       Lateral view of the cervical spine on conventional radiograph should show a comminuted fracture of the vertebral body

o       Soft tissue swelling can be recognized by an increase in the prevertebral soft tissue of greater than the AP diameter of the C3 vertebral body at C3 or greater than the full AP diameter of the cervical vertebral body at C6

o       The anterior portion of the body will be wedged

o       Retropulsion can be inferred if the posterior surface of the vertebral body is convex towards the spinal canal, as the normal cervical vertebral body has a concave posterior surface

o       Injury to the posterior ligamentous structures can be inferred by widening of the interspinous distance and forward subluxation of the vertebral body above the fracture

o       CT will show the comminuted fracture and the retropulsed fragment

 


Burst fracture, C7. Lateral view of the cervical spine demonstrates a comminuted vertical fracture
through the body of C7. The posterior surface of C7 is displaced posteriorly toward the spinal canal (red arrow)
while there is slight soft tissue swelling anteriorly (white arrow).

For a larger photo of the same image without the arrows, click here

 

         Treatment

o       Burst fractures may be treated initially with cervical tongs

o       The fracture is considered stable if there is no neurologic deficit or if there are no retropulsed fragments

 

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