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Joseph Junewick, MD FACR
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Fracture-Dislocation Thoracic Spine

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 6 years ago
Updated: over 5 years ago
Tags: PEDS
Modality/Study Types: CT
Activities:
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History

Teenager involved in motor vehicle accident.


Case Images


Diagnosis

Fracture-Dislocation Thoracic Spine

Findings

CT – Axial and sagittal images show fracture-dislocation at T2-T3. A triangular fragment of the anterior-inferior corner of T2 maintains normal relationship to T3 but the remainder of T2 is distracted superiorly with some sagittal malalignment. The degree of distraction is so severe that there were several axial images that failed to show vertebral elements. Nearly every spinous process is fractured.

Discussion

The thoracic spine is fairly resilient to injury owing to stabiliztion by the shoulder girdle and rib cage. Most thoracic injuries are related to hyperflexion giving rise to compression fractures and hyperflexion-dislocation injuries. Hyperextension injuries in the thoracic region are very uncommon and not usually even mentioned in the various classification schemes. Hyperextension injuries are usually due to falls with the patient’s back landing across a narrow structure such as a fence or a tree limb. The upper thoracic spine however has a slight lordosis and may predispose to hyperextension injuries; conversely the kyphosis likely predisposes to hyperflexion injuries. Increased ligamentous and joint capsular laxity may potentiate hyperextention and hyperflexion thoracic spine injuries.

Reference

Junewick JJ. Cervical Spine Injuries in Pediatrics: Are children small adults or not? Pediatric Radiology 2010; 40(4):493-498.

Reilly CW. Pediatric spine trauma. J Bone Joint Surg Am 2007; 89:98-107



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