Intra-Abdominal injuries in isolated thoracolomber transverse process fractures

Aim: We aimed to investigate the frequency of intra-abdominal injury in posttraumatic isolated transverse process fractures (iTPF) and the factors affecting the injury, especially the effect of the size of the fracture on the injury. Materials and Methods: Patients’ age, gender, trauma type determined by Computed Tomography (CT), fracture localization, separation distance of the fracture from the vertebral body, neurological status, and non-vertebral organ injury, if any, were evaluated retrospectively. Results: Intra-abdominal injury was detected in 16 of 70 patients with iTPF included in the study. The most common cause of iTPF was falls. Those with multiple TPF had a higher rate of intra-abdominal injury. Liver injury was the most common type of intra-abdominal injury. The separation distance of iTPFs from the vertebral body was mean 5.81±1.9 mm in patients with intra-abdominal injury and 3.90±1.69 mm in patients without intra-abdominal injury, and the separation distance was statistically significantly higher in patients with intra-abdominal injury (p < 0.05). Conclusion: This study showed that intra-abdominal injury may be common in cases of iTPF. The severity of the trauma, the high number of fractures, and the length of the fracture distances have caused organ damage to be seen more frequently.

PDF

___

1. Miller CD, Blyth P, Civil IDS. Lumbar transverse process fractures—a sentinel marker of abdominal organ injuries. Injury 200; 31(10): 773-776.
2. Arena JD, Kvint S, Ghenbot Y, et al. Thoracolumbar Transverse Process Fractures Are More Frequently Associated with Nonspinal Injury than Clinically Significant Spine Fracture. World Neurosurgery 2021; 146: 1236-1241.
3. Bui TT, Nagasawa DT, Lagman C, et al. Isolated Transverse Process Fractures and Markers of Associated Injuries: The Experience at University of California, Los Angeles, World Neurosurgery 2017; 104: 82-88.
4. Bradley LH, Paullus WC, Howe J, Litofsky NS. Isolated transverse process fractures: spine service management not needed. Journal of Traumaand Acute Care Surgery 2008; 65(4): 832-836.
5. Homnick A, Lavery R, Nicastro O, Livingston DH, Hauser CJ. Isolated thoracolumbar transverse process fractures: call physical therapy, not spine. Journal of Trauma and Acute Care Surgery 2007; 63(6): 1292-1295.
6. Hauser CJ, Visvikis G, Hinrichs C, et al. Prospective validation of computed tomographic screening of the thoracolumbar spine in trauma. Journal of Traumaand Acute Care Surgery 2003; 55(2): 228-235.
7. 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;215:831-4.
8. Nagasawa DT, Bui TT, Lagman C, et al. Isolated transverse process fractures: a systematic analysis. World Neurosurg 2017;100:336-341.
9. Gültekin G, Yılmaz H, Atcı IB. Psoas Muscle Hematoma Related to Multi-Level Lumbar Vertebrae Transverse Process Avulsion Fracture: A case report. Türk Nörosir Der 2016; 26(1): 75-78
10. Dai LY, Yao WF, Cui YM. Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment- A review of 147 cases. J Trauma 2004;56:348 –355.
11. Akinpelu BJ, Zuckerman SL, Gannon SR, Westrick A, Shannon C, Naftel RP. Pediatric isolated thoracic and/or lumbar transverse and spinous process fractures. J Neurosurg Pediatr 2016; 17:639-644.
12. National Spinal CordInjury Statistical Center. Spinal cordinjury: facts and figures at a glance. Available at: www.spinalcord. uab.edu. Accessed December 17, 2009.
13. Agrawal A, Srivastava S, Kakani A. Isolated transverse process fracture of the lumbar vertebrae. Journal of Emergencies, Trauma and Shock 2009; 2(3): 217.
14. Tian X, Ji-Wei T, Shuang-Hai D, Lei W, Qing-Hua Z.Nonspinal– associated injuries with lumbar transverse process fractures, Journal of Trauma and Acute Care Surgery 2013; 74(4): 1108-1111.
15. Gertzbein SD, Khoury D, Bullington A, St John TA, Larson AI. Thoracic and lumbar fractures associated with skiing and snowboarding injuries according to the AO Comprehensive Classification. Am J Sports Med 2012; 40: 1750-1754.
16. Boulter JH, Lovasik BP, Baum GR, et al. Implications of isolated transverse process fractures: is spine service consultation necessary? . World Neurosurgery 2016; 95: 285-291.
17. Holmes JF, Miller PQ, Panacek EA, Lin S, Horne NS, Mower WR. Epidemiology of thoracolumbar spine injury in blunt trauma. Acad Emerg Med 2001;8: 866-872.
18. Barker PJ, Urquhart DM, Story IH, Fahrer M, Briggs CA. The middle layer of lumbar fascia and attachments to lumbar transverse processes: implications for segmental control and fracture. EurSpine J 2007; 16: 2232–2237.
19. Daglar B, Bayrakçi K, Tasbas BA, et al. Importance of lumbar vertebra transverse process fractures in multi trauma patients who had undergone emergent laparotomy. Turkish Journal Of Trauma & Emergency Surgery 2005; 11(1): 58-63.
20. Mama N, Jemni H, Achour NA, et al. Abdominal trauma imaging. Abdominal Surgery, Ed: Derbel F. 2012. Doi: 10.5772/50426