Monday, March 2, 2015

Leave It Up To

As I just certified in advanced trauma life support, this week will be trauma cases.

A woman is brought into your emergency department after a car crash. She was only wearing a lap belt, and it was positioned a little high, above her pelvic bones. She has a clear seat belt sign on her abdomen. Her neurologic exam is grossly normal. Lumbar spine films are shown above. By chance, you also order a CT abdomen which shows duodenal injury. She's taken immediately to the operating room.

Challenge: Your intern asks what the radiologist has arrowed on the X-ray. What fracture does she have?

Image shown under Fair Use.


RaH said...

wedge shape compression fracture.. a fracture in the spine is defined by a 25% loss of vertebral body height.. so we should measure it to be sure...
it seems like the processus spinosus is fractured as well. the AO surgery reference would classify it as a A1 Type.

Craig Chen said...

good spine read
Leave It Up To

This is a Chance fracture, a flexion-distraction injury of the TL spine that occurs in patients with only a lap belt during vehicular trauma. Sudden deceleration during collision causes forceful flexion at the belt. The X-ray shows a transverse fracture through T12 spinous process (white arrowhead) and a compression fracture of the vertebral body (blue arrow).

Source: UpToDate.