TUGAS SPINAL FRACTURE

By: Richi HW

Denis Classification: The Three-column Concept

Stable and Unstable Fractures

Generally, a fracture is considered stable if only the anterior column is involved, as in the
case of most wedge fractures. When the anterior and middle columns are involved, the
fracture may be considered more unstable. When all three columns are involved, the fracture
is by definition considered unstable, because of the loss of the integrity of the posterior
stabilizing ligaments. The table below shows the types of fractures, the part or parts of the
spine involved, and whether or not it is a stable or unstable injury.
Type of Fracture

Column Affected

Stable vs
Unstable

Wedge fractures

Anterior Only

Stable

Burst fractures

Anterior and middle

Unstable

Fracture/dislocation
injuries

Anterior, middle,
posterior

Unstable

Seat belt fractures

Anterior, middle,
posterior

Unstable

- Classification: (stable or unstable)

- stable frx:
- neurologically intact;
- posterior arch remains intact: pedicle widening implies post arch disruption w/
instability;
- less than 50% anterior body height collapse:
- compression fractures:
- unstable frx:
- neurologic deficit;
- loss of 50% of vertebral body height;
- fracture dislocation:
- thoracolumbar burst frx:
- angulation of the thoracolumbar junction > 20 deg
- canal comprimise > 30 percent

- Non Operative Treatment:

- non operative treatment remains the standard for compression fx;
- most pts can be treated symptomatically w/ short period of bed rest until
pain is diminished;
- in some cases an NG tube is required for severe ileus;
- if bowel sounds and flatus are not present then patient should be made
NPO, and should receive IV Fluid;
- early ambulation is encouranged in a hyperextion orthosis;
- avoidance of compression overloads for a period of 12 weeks;
- depending on degree of compression, pt may be treated effectively by
hyperextension exercises & avoidance of compression overloads for period of
approximately 12 weeks.
- early ambulation is encouraged in a hyperextension orthosis.
-Observation for 3 month.
--for 3 months.