Thoracic spine fracture dislocation
High speed motorbike accident, struck road divider
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1. Acute translational fracture-dislocation at the level of T5/6, with left anteroinferolateral displacement of the T5 vertebral body relative to T6.
2. T4 vertebral body comminuted fracture with fracture lines extending through the bilateral pedicles and articular facets. Fractured T3-5 spinous processes, right T4/T5 transverse processes, and left T2-4/T6 transverse processes.
3. Fractured right posterolateral ribs 1, 2, T4-7, and left posterior ribs 1-6. No sternal fracture. Fractured right inferior angle of scapula.
4. Bilateral pneumothorax, greater on the right side. Bilateral intercostal catheters in-situ with associated subcutaneous emphysema. Bilateral dense lung consolidation, predominately in the upper zones. Bilateral pleural effusion, larger on the left side. Small (1.5 cm) traumatic pneumatocoele in the left apex.
5. No aortic or greater vessel injury
The thoracic spine is rigidly stabilized by the anterior, middle and posterior spinal columns. Fracture-dislocation in this region generally necessitates very high-energy trauma. Complete fracture dislocation of the thoracic spine leads to paraplegia in the vast majority of cases.
This very fortunate 35-year old male presented, post a high speed (100+ km/hr) motorbike accident, with no other neurological deficit except some left lateral chest wall paraesthesia - he had full sensory and motor function of all four limbs. Sparing of the spinal cord is possible if the posterior spinal elements (bilateral pedicles or facets) become spontaneously dissociated from their vertebral bodies, leading to widening and decompression of the spinal canal and room for the spinal cord to escape injury 1.
The close anatomical relationship between the thoracic spine and descending aorta should also raise suspicion of possible traumatic aortic injury. No aortic injury was found in this case.