FRACTURES OF THE TRANSVERSE PROCESSES OF THE LUMBAR VERTEBRÆ

Abstract

There is apparentIy considerabIe difference of opinion in regard to the frequency, importance and treatment of fractures of the transverse processes of the Iumbar vertebrae. From the scarcity of references to this injury one wouId think the Iesion either rare or of IittIe moment. Some even suggest that it is non-existent, the roentgen-ray appearance being due to bony abnormality. A knowIedge of the amount of disabiIity caused is important, for one thing, in estimating insurance Ioss, as many of these are compensation cases. Some state that proIonged immobiIization or more radica1 procedure is necessary, apparentIy feeIing that they are deaIing with an injury foIIowed by considerabIe disability. This paper reviews the Iiterature and our experience in IO cases at the SurgicaI CIinic of the Beekman Street HospitaI. Among injuries to the back, fractures of the transverse processes of the Iumbar vertebrae are not rare, aIthough it is to be emphasized that bony anomaIies in this region are frequent and may tend to confuse the diagnosis. The most common cause of fracture of the transverse processes is direct vioIence. The symptoms and physica signs are those of a severe sprain or contusion of the back. Sudh fractures are usuaIIy muItipIe. When uncompIicated by body fracture, a11 the fractures are usuaIIy on the same side. The disabiIity caused by the injury is due soIeIy to the associated contusion or sprain of the back, and the presence of the fracture is negIigibIe as far as proIongation of disability is concerned. Owing to the frequency of traumatic neurosis, it is preferabIe that knowIedge of an existing fracture be kept from the patient. Bony union of the fractured transverse processes is definite in some of these cases. More carefu1 examination of backs shouId be made before empIoying men over forty at hard Iabor. The treatment required is rest in bed, heat and massage. ProIonged immobiIization is no more necessary than in any contusion or sprain of the back. In this series patients were abIe to waIk after an average period of sixteen days. DisabiIity over six months is out of the ordinary. The majority of patients shouId be at work within two months with practicaIIy no compIaints referabIe to the injury.