Thoracic spine fractures

Acute unexplained T1-T2 fracture-dislocation following posterior instrumentation and fusion for paralytic scoliosis

INTRODUCTION AND IMPORTANCE

Upper thoracic fracture-dislocation following posterior instrumentation and fusion is rare, with potentially devastating neurologic consequences. The recommended treatment is an open reduction, spinal cord decompression, and a proximal extension of spinal instrumentation. To report the diagnosis and management of an acute non-traumatic T1-T2 fracture-dislocation, occurring in the early postoperative course of a posterior instrumentation and fusion for neurogenic scoliosis.

CASE REPORT

A 12-year-old spastic quadriplegic cerebral palsy (CP) male patient, who underwent an uneventful T2-S1 instrumentation for scoliosis, presented to the emergency department (ED) 2 weeks later, with mild fever, urinary retention, fecaloma and hypotonia of the 4 limbs, of few days duration. His parents reported no history of trauma and denied epileptic seizures. Atypical cervicothoracic spastic movements the night preceding his symptoms were the only relevant events of the patient's history. CT and MRI were both suggestive of a complete T1-T2 fracture-dislocation and spinal cord compromise.

CLINICAL DISCUSSION

The patient underwent immediate posterior decompression with wide lamino-arthrectomy, open reduction and proximal extension of his posterior instrumentation to C5. One year following surgery, there was only mild sensorimotor and bladder and bowel function recovery.

CONCLUSION

To our knowledge, this is the first report of an acute non-traumatic unexplained T1-T2 fracture-dislocation following posterior instrumentation and fusion. Despite a proper management, only very mild recovery was observed one year following surgery.

Examination and Scientific Analysis of Thoracic Vertebral Fractures

Background Thoracic vertebral fractures are clinically important due to their association with the thoracic spinal cord and the potential to cause devastating neurological injury. Using the National Electronic Injury Surveillance System (NEISS) data, this study investigated fracture patterns to understand associated factors to improve prevention strategies. We explored different factors associated with thoracic vertebral fractures to improve our understanding of preventative strategies and patient care standards, focusing on spatial distribution, sex-age dynamics, and location of injury. Methodology This retrospective, cross-sectional study examines thoracic vertebral fractures across diverse age groups from 2013 to 2022, utilizing the NEISS database from the U.S. Consumer Product Safety Commission. Inclusion criteria based on specific terms related to thoracic fractures were employed. Descriptive statistics illustrated fracture distribution by age groups and associated products. Statistical analyses, including chi-square tests and multivariate logistic regressions, were conducted to explore associations between fracture occurrence, locations, products, age, and gender. Results The analysis of thoracic vertebral fractures by location and associated products yielded several statistically significant findings. Notably, the prevalence of fractures at home (39.67%) was significantly higher than in other locations, and these differences in fracture distribution were statistically significant (χ² = 7.34, p < 0.001). Among the associated products, ladders (10.46%) emerged as the most frequent product associated with fractures. Multivariate logistic regression analysis showed that the age groups of 41-50, 51-60, and 61-70 had increased odds of fractures with adjusted odds ratios (AORs) of 1.08 (95% confidence interval (CI) = 1.04-1.42, p < 0.05), 1.21 (95% CI = 1.13-1.56, p < 0.001), and 1.17 (95% CI = 1.08-1.39, p < 0.001), respectively. The likelihood of thoracic vertebral fractures did not significantly differ between males and females (AOR = 1.12, 95% CI = 0.87-1.53, p = 0.262). Fracture distribution by age groups and products indicated increasing ladder-related fractures within the 41-50 age group and 51-60 age group. Football-related fractures peaked within the 21-30 age group. Fracture distribution patterns for bicycles had increased prevalence within the 11-20 and 21-30 age groups, and football-related fractures in younger age groups. Conclusions This study analyzed factors associated with thoracic vertebral fractures, showing the significance of targeted preventative interventions, such as earlier screening, physical therapy, and nutritional status assessment, in the setting of significant location and age-related susceptibilities. The observed patterns of injury provide a foundation for future research to elucidate the underlying mechanisms between different environments and the likelihood of injury to improve preventive strategies.

Patterns of concomitant injury in thoracic spine fractures

Background

Thoracic spine fractures (TSFs) are rarely isolated injuries, and they tend to present with a characteristic set of vertebral and non-vertebral injuries based on mechanism of injury. There is limited research on the rates and distribution of injuries that occur concurrently with TSFs. The purpose of this study is to characterize the distributions of these injuries by region of the body and by mechanisms of injury, so that trauma and spine surgeons can efficiently evaluate and treat patients presenting with TSFs.

Methods

We retrospectively reviewed the trauma database records of 683 patients presenting with a TSFs at a single institution from 2015 to 2019. We recorded patient demographics, comorbidities, and associated injuries by body region. We characterized the TSFs using the AO classification system, as well as the presenting physical exam and treatment. All associated injuries among the TSF patients were classified into the following categories: head injury (HI), thoracic injury (TI), non-thoracic vertebral injury (NTVI), abdominal injury (AI), upper extremity injury (UEI), lower extremity injury (LEI), and spinal cord injury (SCI).

Results

The three leading causes of TSFs were mechanical falls (38.4%), falls from height (24.9%), and motor vehicle crashes (MVCs) (23.4%). Patients with a TSF from MVC were statistically more likely to have concomitant injuries of TI, NTVI, AI, HI, UEI, and LEI. TSFs from fall from height were statistically more likely to have TI, NTVI, and LEI. TSFs from mechanical falls had significantly lower rates of all injury locations, but still presented with high rates of additional injury. TSFs from motorcycle crashes (MCCs) presented with TI, AI, UEI, and LEI. There were high rates of treatment for TSFs, with surgery ranging from 5.3% to 20.0% and bracing from 52.3% to 65.7% depending on mechanism of injury.

Conclusions

TSFs after MVCs, mechanical falls, falls from height, and MCCs presented with a predictable pattern of injuries and were rarely an isolated injury. This cross-sectional data may help spine and trauma surgeons better understand patterns of injury associated with TSFs, with the hope of preventing missed injuries and better advising patients with TSFs on severity of injuries.

Clinical characteristics and treatment of fracture-dislocation of thoracic spine with or without minimal spinal cord injury

BACKGROUND

It is important to evaluate clinical efficacy and safety of posterior internal fixation using pedicle screw system.

OBJECTIVES

To investigate clinical characteristics of patients diagnosed with fracture-dislocation of the thoracic spine with or without minimal spinal cord.

METHODS

Twenty-eight patients with fracture-dislocation of thoracic spine with or without minimal spinal cord injury were retrospectively analyzed. All patients received posterior reduction and internal fixation using pedicle screw system.

RESULTS

The mean follow-up duration was 11.4 months. Among 28 patients, 24 cases were complicated with bilateral pedicle or laminal fracture. Preoperatively, the percentage of vertebral displacement was (32.1 ± 20.6)%, significantly declined to (7.5 ± 6.0)% (t= 4.575, P= 0.001) and maintained at (7.9 ± 6.3)% at the final follow-up. Preoperative local kyphosis angle was measured as (16.2 ± 11.3)∘, restored to (15.4 ± 5.9)∘ postoperatively and (15.8 ± 5.4)∘ during the final follow-up. No statistical significance was observed at three time points (all P> 0.05). The remaining 25 patients were evaluated with normal and complete neurological function. No severe complications were observed intra- and postoperatively.

CONCLUSIONS

Posterior internal fixation using pedicle screw is an efficacious and safe therapy which achieves proper reduction and preserves spinal cord function.

Diabetes Comorbidity Increases Risk of Postoperative Complications in Traumatic Thoracic Vertebral Fracture Repair: A Propensity Score Matched Analysis

BACKGROUND

Thoracic vertebral fracture repair after a traumatic injury can be associated with significant risk for postoperative complications. Surgical outcomes are further complicated by patient comorbidity, particularly diabetes mellitus. This study compared outcomes and complication rates for traumatic thoracic vertebral fracture repair in a matched sample of patients with diabetes and nondiabetic control subjects.

METHODS

Patients with a surgical repair of a trauma-induced thoracic vertebral fracture treated from 2010 to 2015 were identified from the Trauma Quality Improvement Program database, yielding 5557 cases. Patients with comorbid diabetes were matched by propensity score matching (PSM) with patients without diabetes on age, race, and body type and were compared by postoperative complications and clinical outcomes.

RESULTS

Prior to PSM, the diabetes group was older on average and had a greater proportion of patients who were obese (Ps < 0.001). After PSM, each group consisted of 544 patients (N = 1088) and no longer differed by any baseline characteristic. Comorbid diabetes was associated with longer average length of hospital stay and greater frequency of several major and minor postoperative complications (Ps < 0.05), including prolonged intensive care, pneumonia, acute renal failure, stroke, pressure ulcers, and urinary tract infections, but no differences were found in reoperation rates or in-hospital mortality.

CONCLUSIONS

Diabetes comorbidity can significantly increase the risk of postoperative complications after traumatic thoracic vertebral fracture repair, which may lead to delayed recovery and greater health care-related costs. This finding is an important consideration for surgical decision-making and patient counseling on treatment options with this comorbid condition.

Mechanism of Injury and Clinical Variables in Thoracic Spine Fracture: A Case Control Study

Objective

To determine the mechanisms of injury and clinical findings significantly associated with traumatic thoracic spine (T-spine) fractures.

Methods

This was a case-control study in a tertiary adult trauma centre. Cases were patients admitted with traumatic T-spine fractures between January 1999 and August 2007, inclusive. Each case had two controls matched for gender, age and injury severity. Data were collected from patient medical records and the trauma service database. Factors potentially associated with T-spine fracture were derived from the literature, expert consensus and univariate analysis. Multivariate logistic regression was employed to determine factors significantly associated with T-spine fracture.

Results

Two hundred and sixty one cases and 512 controls were enrolled. Univariate analysis showed the mechanisms of fall from a height ≥2 meters (m) and motorbike accident ≥60 kilometers per hour were significantly associated with T-spine fracture (p<0.001). The clinical findings of thoracic back pain, tenderness, intoxication, step deformity and abnormal neurological symptoms were also significantly associated with T-spine fracture (p<0.05). Multivariate analysis indicated that falls from a height of ≥2 m and thoracic back pain were significantly and positively associated with T-spine fracture (p<0.001). However, intoxication was negatively associated with T-spine fracture.

Conclusions

Patients with T-spine injury are significantly more likely to have fallen from a height ≥2 m or to have had thoracic back pain but less likely to be intoxicated. These findings should be validated prospectively prior to development of clinical guidelines for the identification of patients who may benefit from CT screening of the thoracic spine.

3D printing-assisted preoperative plan of pedicle screw placement for middle-upper thoracic trauma: a cohort study

BACKGROUND

This study aimed to evaluate the application of 3D printing in assisting preoperative plan of pedicle screw placement for treating middle-upper thoracic trauma.

METHODS

A preoperative plan was implemented in seven patients suffering from middle-upper thoracic (T3-T7) trauma between March 2013 and February 2016. In the 3D printing models, entry points of 56 pedicle screws (Magerl method) and 4 important parameters of the pedicle screws were measured, including optimal diameter (ϕ, mm), length (L, mm), inclined angle (α), head-tilting angle (+β), and tail-tilting angle (-β). In the surgery, bare-hands fixation of pedicle screws was performed using 3D printing models and the measured parameters as guidance.

RESULTS

A total of seven patients were enrolled, including five men and two women, with the age of 21-62 years (mean age of 37.7 years). The position of the pedicle screw was evaluated postoperatively using a computerized tomography scan. Totally, 56 pedicle screws were placed, including 33 pieces of level 0, 18 pieces of level 1, 4 pieces of level 2 (pierced lateral wall), and 1 piece of level 3 (pierced lateral wall, no adverse consequences), with a fine rate of 91.0%.

CONCLUSIONS

3D printing technique is an intuitive and effective assistive technology to pedicle screw fixation for treating middle-upper thoracic vertebrae, which improve the accuracy of bare-hands screw placement and reduce empirical errors.

TRIAL REGISTRATION

The trial was approved by the Ethics Committee of the Fujian Provincial Hospital. It was registered on March 1st, 2013, and the registration number was K2013-03-001.

Severe fracture-dislocation of the thoracic spine without any neurological deficit

Background

Fracture-dislocations of the thoracic spine without spinal cord injury are very rare.

Case presentation

A 35-year-old woman presented to our emergency department with complete T6-7 fracture-dislocation without any neurological loss had undergone a surgical reduction and fixation.

Conclusions

The radiological severity of fracture-dislocation pattern doesn’t correlate sometimes with the clinical manifestation.

The unstable thoracic cage injury: The concomitant sternal fracture indicates a severe thoracic spine fracture

INTRODUCTION

The thoracic cage is an anatomical entity composed of the upper thoracic spine, the ribs and the sternum. The aims of this study were primarily to analyse the combined injury pattern of thoracic cage injuries and secondarily to evaluate associated injuries, trauma mechanism, and clinical outcome. We hypothesized that the sternal fracture is frequently associated with an unstable fracture of the thoracic spine and that it may be an indicator for unstable thoracic cage injuries.

PATIENTS AND METHODS

Inclusion criteria for the study were (a) sternal fracture and concomitant thoracic spine fracture, (b) ISS≥16, (c) age under 50 years, (d) presence of a whole body computed-tomography performed at admission of the patient to the hospital. Inclusion criteria for the control group were as follows: (a) thoracic spine fracture without concomitant sternal fracture, (b)-(d) same as study cohort.

RESULTS

In a 10-year-period, 64 patients treated with a thoracic cage injury met inclusion criteria. 122 patients were included into the control cohort. In patients with a concomitant sternal fracture, a highly unstable fracture (AO/OTA type B or C) of the thoracic spine was detected in 62.5% and therefore, it was significantly more frequent compared to the control group (36.1%). If in patients with a thoracic cage injury sternal fracture and T1-T12 fracture were located in the same segment, a rotationally unstable type C fracture was observed more frequently. The displacement of the sternal fracture did not influence the severity of the concomitant T1-T12 fracture.

CONCLUSIONS

The concomitant sternal fracture is an indicator for an unstable burst fracture, type B or C fracture of the thoracic spine, which requires surgical stabilization. If sternal and thoracic spine fractures are located in the same segment, a highly rotationally unstable type C fracture has to be expected.

Office hours vs after-hours. Do presentation times affect the rate of missed injuries in trauma patients?

BACKGROUND

A number of studies have investigated the effect of presentation time on the outcome of patients presenting following trauma. However, it is uncertain whether there is a difference in the incidence of missed injuries between patients presenting during 'office hours' to those presenting in the 'after-hours' period.

MATERIALS AND METHODS

We analysed all patients recorded in the Trauma Registry of Royal Perth Hospital (a Level I Trauma Centre for adults in Western Australia) between 2003 and 2013. Patients were divided into 3 groups i.e. those presenting during office hours, those presenting 'after-hours' on a weekday and those presenting on a weekend. In 2008, the State Major Trauma Unit (SMTU) at RPH was initiated following which in-hospital cover by the Trauma Fellows was extended to 11 PM on weekdays. The study was therefore divided into two time periods i.e. pre-SMTU (2003-2007) and post-SMTU (2008-2013).

RESULTS

53,030 patients were recorded in the Trauma Registry in the 10-year period (major and minor trauma). There were 2519 missed injuries in 1262 patients (2.4%). Of these, 2.2% patients presented during office hours, 2.6% 'after-hours on a weekday' and 2.5% on weekends. The odds of missing an injury were 1.2 times higher if the patient presented after-hours (p=0.048). Missed injury rates were found to have increased over the past 10 years (p=0.0179). The odds of missing an injury in 2013 were 1.34 times higher than in 2003. Most of the missed injuries were AIS 1 and 2 (19.8 and 59%) and 55% had no clinical impact on the patients. Thoracic Spine and abdominal injuries were most commonly missed. The only region to show a significant difference between the 3 groups of patients studied was the abdomen (5.3% vs 11.1% vs 6.3%; p=0.004). It was also seen that a larger number of hollow viscus abdominal injuries (5.2%) were missed when compared to solid organs (3.2%; p<0.001).

CONCLUSION

Injuries in patients sustaining trauma are more likely to be missed 'after-hours' than during 'office hours'. T-spine and abdominal injuries are more likely to be missed when compared to other anatomical regions of the body.

Severe thoracic spinal fracture-dislocation without neurological symptoms and costal fractures: a case report and review of the literature

Introduction

Only a high-energy force can cause thoracic spinal fracture-dislocation injuries, and such injuries should always be suspected in patients with polytrauma. The injury is usually accompanied by neurological symptoms. There are only a few cases of severe thoracic spinal fracture-dislocation without neurological symptoms in the literature, and until now, no case of severe thoracic spinal fracture-dislocation without neurological symptoms and without costal fractures has been reported.

Case presentation

A 30-year-old Han Chinese man had T6 to T7 vertebral fracture and anterolateral dislocation without neurological symptoms and costal fractures. The three-dimensional reconstruction by computed tomography and magnetic resonance imaging indicated the injuries in detail. A patient with thoracic spinal fracture-dislocation without neurological symptoms inclines to further dislocation of the spine and secondary neurological injury; therefore, laminectomy, reduction and internal fixations with rods and screws were done. The outcome was good. Severe spinal fracture-dislocation without neurological symptoms should be evaluated in detail, especially with three-dimensional reconstruction by computed tomography. Although treatment is individualized, reduction and internal fixation are advised for the patient if the condition is suitable for operation.

Conclusions

Severe thoracic spinal fracture-dislocation without neurological symptoms and costal fractures is frighteningly rare; an operation should be done if the patient's condition permits.

Health-related quality-of-life outcomes after thoracic (T1-T10) fractures

BACKGROUND CONTEXT

The thoracic spine exhibits a unique response to trauma as the result of recognized anatomical and biomechanical differences. Despite this response, clinical studies often group thoracic fractures (T1-T10) with more caudal thoracolumbar injuries. Subsequently, there is a paucity of literature on the functional outcomes of this distinct group of injuries.

PURPOSE

To describe and identify predictors of health-related quality-of-life outcomes and re-employment status in patients with thoracic fractures who present to a spine injury tertiary referral center.

STUDY DESIGN

An ambispective cohort study with cross-sectional outcome assessment.

PATIENT SAMPLE

A prospectively collected fully relational spine database was searched to identify all adult (>16 years) patients treated with traumatic thoracic (T1-T10) fractures with and without neurologic deficits, treated between 1995 and 2008.

OUTCOME MEASURES

The Short-Form-36, Oswestry Disability Index, and Prolo Economic Scale outcome instruments were completed at a minimum follow-up of 12 months. Preoperative and minimum 1-year postinjury X-rays were evaluated.

METHOD

Univariate and multivariate regression analysis was used to identify predictors of outcomes from a range of demographic, injury, treatment, and radiographic variables.

RESULTS

One hundred twenty-six patients, age 36±15 years (mean±SD), with 135 fractures were assessed at a mean follow-up of 6 years (range 1-15.5 years). Traffic accidents (45%) and translational injuries (54%) were the most common mechanism and dominant fracture pattern, respectively. Neurologic deficits were frequent-53% had complete (American Spinal Injury Association impairment scale [AIS] A) spinal cord deficits on admission. Operative management was performed in 78%. Patients who sustain thoracic fractures, but escaped significant neurologic injury (AIS D or E on admission) had SF-36 scores that did not differ significantly from population norms at a mean follow-up of 6 years. Eighty-eight percent of this cohort was re-employed. Interestingly, Oswestry Disability Index scores remained inferior to healthy subjects. In contrast, SF-36 scores in those with more profound neurologic deficits at presentation (AIS A, B, or C) remained inferior to normative data. Fifty-seven percent were re-employed, 25% in their previous job type. Using multiple regression analysis, we found that comorbidity status (measured by the Charlson Comorbidity index) was the only independent predictor of SF-36 scores. Neurologic impairment (AIS) and adverse events were independent predictors of the SF-36 physical functioning subscale. Sagittal alignment and number of fused levels were not independent predictors.

CONCLUSIONS

At a mean follow-up of 6 years, patients who presented with thoracic fractures and AIS D or E neurologic status recovered a general health status not significantly inferior to population norms. Compared with other neurologic intact spinal injuries, patients with thoracic injuries have a favorable generic health-related quality-of-life prognosis. Inferior outcomes and re-employment prospects were noted in those with more significant neurologic deficits.

Thoracic spine fractures: injury profile and outcomes of a surgically treated cohort

There are only few reports in literature about the treatment of traumatic lesions of the thoracic spine. They have been grouped together with thoracolumbar fractures, ignoring the particular biomechanics of the thoracic segment. The objective of this retrospective cohort is to describe the clinical presentation and outcomes of surgically treated patients with these injuries. Data were obtained from the institutional database of medical registries, identifying all the patients who had been treated for thoracic spine fractures, from January 1, 1995 through December 31, 2005 in our institution. The study group included the 51 surgically treated patients. General and surgery-related complications were considered as clinical outcomes and injury-related disability was also assessed. Statistical analysis evaluating possible associations with timing and type of surgery, neurological impairment and associated injuries was carried out. Motor vehicle accident was the most frequent mechanism of injury. Six patients had an incomplete neurological deficit, whereas 22 had a complete lesion. Thirty-two patients presented at least one complication. Five of the neurologically intact patients, while 20 of those with neurological impairment presented general complications (p = 0.0001). None of the patients' neurological status deteriorated after surgery. All patients with complete spinal cord injury and those with incomplete cord injury with partial functional recovery received disability compensation. Short pedicle instrumentations should be used whenever possible, but also long instrumentations and mixed constructs may be necessary for the management of such unique fractures.

Thoracic Injuries in earthquake-related versus non-earthquake-related trauma patients: differentiation via Multi-detector Computed Tomography

PURPOSE

Massive earthquakes are harmful to humankind. This study of a historical cohort aimed to investigate the difference between earthquake-related crush thoracic traumas and thoracic traumas unrelated to earthquakes using a multi-detector Computed Tomography (CT).

METHODS

We retrospectively compared an earthquake-exposed cohort of 215 thoracic trauma crush victims of the Sichuan earthquake to a cohort of 215 non-earthquake-related thoracic trauma patients, focusing on the lesions and coexisting injuries to the thoracic cage and the pulmonary parenchyma and pleura using a multi-detector CT.

RESULTS

The incidence of rib fracture was elevated in the earthquake-exposed cohort (143 vs. 66 patients in the non-earthquake-exposed cohort, Risk Ratio (RR) = 2.2; p<0.001). Among these patients, those with more than 3 fractured ribs (106/143 vs. 41/66 patients, RR=1.2; p<0.05) or flail chest (45/143 vs. 11/66 patients, RR=1.9; p<0.05) were more frequently seen in the earthquake cohort. Earthquake-related crush injuries more frequently resulted in bilateral rib fractures (66/143 vs. 18/66 patients, RR= 1.7; p<0.01). Additionally, the incidence of non-rib fracture was higher in the earthquake cohort (85 vs. 60 patients, RR= 1.4; p<0.01). Pulmonary parenchymal and pleural injuries were more frequently seen in earthquake-related crush injuries (117 vs. 80 patients, RR=1.5 for parenchymal and 146 vs. 74 patients, RR = 2.0 for pleural injuries; p<0.001). Non-rib fractures, pulmonary parenchymal and pleural injuries had significant positive correlation with rib fractures in these two cohorts.

CONCLUSIONS

Thoracic crush traumas resulting from the earthquake were life threatening with a high incidence of bony thoracic fractures. The ribs were frequently involved in bilateral and severe types of fractures, which were accompanied by non-rib fractures, pulmonary parenchymal and pleural injuries.

Crush thoracic trauma in the massive Sichuan earthquake: evaluation with multidetector CT of 215 cases

PURPOSE

To determine the multidetector computed tomographic (CT) features of crush thoracic traumas resulting from the massive Sichuan earthquake.

MATERIALS AND METHODS

This study was approved by the ethics committee of the medical school, and informed consent was waived. A retrospective review was undertaken of 215 multidetector chest CT scans of 112 male and 103 female patients who sustained crush thoracic injuries in the Sichuan earthquake at 2:28 pm Beijing time, May 12, 2008, and were rescued in the authors' hospital. Multidetector chest CT studies were performed between May 12, 2008, and June 7, 2008. The authors looked for injuries to the thoracic cage, pulmonary parenchyma, and pleura.

RESULTS

One hundred forty-three patients (66.5%; 95% confidence interval [CI]: 60.2%, 72.8%) had at least one rib fracture; the mean number of rib fractures per patient was 6 [corrected]. Forty-five of these patients (31.5% of 143 patients; 95% CI: 23.9%, 39.1%) had flail chest, with a total of 288 ribs fractured. There were 46 patients (21.4%; 95% CI: 15.9%, 26.9%) with at least one vertebral fracture. There were 77 vertebral fractures total; 36 of these fractures were in T1 through T10. Twelve patients (5.6%; 95% CI: 2.5%, 8.7%) had sternal fractures, and 48 patients (22.3%; 95% CI: 16.7%, 27.9%) had either scapular or clavicular fractures. There were 117 patients (54.4%; 95% CI: 47.7%, 61.1%) with pulmonary parenchymal injuries and 146 (67.9%; 95% CI: 61.7%, 74.1%) with pleural injuries.

CONCLUSION

Crush thoracic trauma resulting from the massive Sichuan earthquake was a life-threatening injury; this type of injury has the potential for multiple fractures and pulmonary parenchymal injuries.

Injuries significantly associated with thoracic spine fractures: a case-control study

OBJECTIVE

To determine injuries significantly associated with traumatic thoracic spine (T-spine) fractures

METHODS

This was a case-control study undertaken in an adult trauma centre. Cases were patients admitted with a traumatic T-spine fracture between January 1999 and August 2007. Each case had two controls matched for sex, age (+/-5 years) and injury severity classification (major/minor). Data were collected from patient medical records and the trauma service database. Multivariate logistic regression was used to determine injuries significantly associated with T-spine fracture.

RESULTS

Two hundred and sixty-one cases and 512 controls were enrolled. In both groups, mean age was 41 years and 70% of patients were male. Univariate analysis revealed a range of injuries that were significantly more common among the cases, especially cervical and lumbar spine injuries, sternal/scapular/clavicular/rib fractures, pneumo/haemothorax and pulmonary contusions (P < 0.01). Skull fractures and lower limb injuries were significantly more common among the controls (P < 0.01). Logistic regression analysis revealed that only cervical and lumbar spine injuries and rib fractures were positively associated with T-spine fracture (P < 0.001). Skull fractures and lower limb injuries were negatively associated with T-spine injury (P < 0.001).

CONCLUSION

Cervical and lumbar spine injuries and rib fractures are significantly associated with T-spine fracture. The presence of these injuries should raise suspicion of concomitant T-spine injury.