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Thoracolumbar Fractures
Compare to vertebra
adjacent to injured one
Anterior Column Fx Treatment
Simple compressions can be
placed in a Jewett or TLSO off
the shelf brace and discharged
from the ED or office as long as
pain is controlled, fracture is
stable with new standing x-rays in
brace and they dont have an
ileus. Cannot treat fractures above
T6 without cervical extension
Stable Bursts and Lateral
Compression Fractures
Admit- pain mgmt and
neuro checks
Brace management -Off the
shelf TLSO for simple
compressions greater than
30% and lateral
compressions, Custom
TLSO for unusual body
habitis, severe bursts and pts
that need stability testing.
CASH for insufficiency Fxs
Complications from Fracture
Pneumothorax (thoracic Fxs with asso rib Fxs)/
Ileus(30-60%)
Splenic, liver and vessel injury (mechanism of injury)
DVT/PE
Decubitis
UTI
Pneumonia
Renal failure (hydronephrosis from cauda equina
involvement)
Stress Testing
Fracture that may be
unstable in custom TLSO
Bed rest until TLSO
arrives
X Rays supine/ 45deg/ 90
deg/ upright
Stop if neuro involvement,
sig. Pain increase or sig.
Increased kyphosis
45 degrees vs upright
Surgical Indications
Neurological Involvement
Flexion distraction injury
Greater than 50% canal compromise with
>15 degrees kyphosis
>25 degrees kyphosis
Failure of stress testing (severe pain,
angulation above 25 degrees, neuro
symptoms)
Fracture dislocations
Soft tissue chance fractures
Time to healing
Most non-surgical fractures heal within 12 weeks
Jewett/ TLSO on whenever upright
When healed- 4 weeks of PT for deconditioning
Residuals of barometric sensitive discomfort and
occasionally problems with lifting
10 % may need to go on to surgery from
instability pain
Thank You