Burst Fracture

FACTS

  • typically 2/2 axial load → extension injury
  • mainly occur at T/L junction (T10-L2)
  • superior endplate more commonly involved than inferior endplate
  • anterior, middle columns impacted, but posterior column is intact in a burst fracture
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A3: Incomplete Burst

  • no involvement of posterior wall
  • 1 endplate fx
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A4: Complete burst fracture

  • no involvement of posterior wall
  • 2 endplate fractures
 

HPI

  • standard spine history

PHYSICAL EXAM

  • standard spine exam

IMAGING

  • scroll through axial images and prove to yourself that the pedicles and posterior column are intact
  • evaluate for retropulsed bone in spinal canal → this will help decide whether to get an MRI
Figure 1: L1 complete burst fracture with significant bony retropulsion into spinal canal
Figure 1: L1 complete burst fracture with significant bony retropulsion into spinal canal
A/P
  • Considered unstable fractures, but generally can be braced.
  • Operative if bony fragments causing cord/thecal sac compression.

Denis Spinal Columns

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  • Anterior column: ALL + anterior 1/2 of VB
  • Middle column: posterior 1/2 of VB + PLL
  • Posterior column: pedicles, facets, supraspinous ligaments, posterior bony structures