Spinal wedge fracture

Last revised by Dr Daniel J Bell on 01 Dec 2021

Spinal wedge (compression) fractures are hyperflexion injuries to the vertebral body resulting from axial loading. Most commonly affecting the anterior aspect of the vertebral body, wedge fractures are considered a single-column (i.e. stable) fracture. 

Less commonly wedge fractures refer to a subtype of tibial plateau fractures

Most common type (~50%) of thoracolumbar spine fractures 4

Typically, these fractures are insufficiency fractures secondary to osteoporosis, although some are pathological secondary to a focal bone lesion. A small proportion is due to trauma in patients with normal underlying bone 2.

See: AO spine classification of thoracolumbar injuries.

Radiographs, CT, and MRI may show cortical disruption with impaction of one endplate without the involvement of the posterior wall 6. This results in the characteristic "wedged" appearance 3,4

  • burst fracture: fracture of the anterior and posterior vertebral body (i.e. two-column injury) 4
  • split or pincer fracture: superior and inferior endplate fracture without posterior wall involvement 6
  • care should be taken to assess for posterior ligamentous injury, indicative of potential instability

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Cases and figures

  • Figure 1: acute vs chronic
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  • Case 1
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  • Case 2
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  • Case 3
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  • Case 4: multiple fractures
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  • Case 5: with a spinal synovial cyst
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