Fracture-Dislocation of the Upper Thoracic Spine without Neurologic Associated Injury: Two Cases Report

Abstract

Upper thoracic fractures are produced by high-energy trauma. Fracture-dislocation (type C Association) for the Study of Internal Fixation (AO classification) of the upper thoracic spine represents 15% of all thoracic and lumbar fractures. The neurological injury occurs in 80% of cases, being extremely rare type C fractures without spinal cord injury. We report a case of 51 years-old male with no past medical history, who was brought to our Hospital after falling from a 10 meters high roof. He had 15 points at Glasgow Coma Scale (GCS) and a completely normal neurological examination. A whole body computerized tomography (CT) scan was performed and diagnosed a fracture-dislocation at T8-T9. Acute surgery was decided, performing an open reduction and internal fixation with pedicle screws from T6 to T1. Clinical outcome was favorable. The second case is a 29 years old patient, who suffered a motorcycle accident. On arrival at critics room presented 14 points at GCS and American Spinal Injury Association scale (ASIA) E. After whole CT scan, was diagnosed a T10 fracture-dislocation, an open left iliac fracture, open right distal tibia fracture and a fracture of 10th left costal arch. Acute surgery was decided: performing external fixation of right tibia, wound cleaning and exploration of iliac crest and open reduction and fixation of the fracture-dislocation of thoracic spine. After nine days from the first surgery an open reduction and internal fixation (ORIF) of the right distal tibia was performed and a closed reduction and internal fixation (CRIF) of tibial plateau fracture. Ligamentoplasty of anterior cruciate ligament (ACL) of the right knee was also done arthroscopically. Clinical outcome was satisfactorily. The fracture-dislocation of the upper thoracic spine is often associated with spinal cord injury, there is a very few reported cases in bibliography without neurological damage. The initial clinical management of this patients is crucial at critics room, Advanced Trauma Life Support (ATLS) must be applied and subsequently perform a damage control. In patients with upper thoracic fracturedislocation without spinal cord involvement, immediate reduction and osteosynthesis should always be performed.