Abstract
ABSTRACT Objective To analyze the behavior of thoracolumbar fractures of the coronal split type using the finite element method. Methods Two comparative studies were conducted through simulation of coronal split fractures in a finite model in which the first lumbar vertebra (L1) was considered to be fractured. In the first case, the fracture line was considered to have occurred in the middle of the vertebral body (50%), while in the second model, the fracture line occurred in the anterior quarter of the vertebral body (25%). The maximum von Mises stress values were compared, as well as the axial displacement between fragments of the fractured vertebra. Results The stress levels found for the fracture located at half of the vertebral body were 43% higher (264.88 MPa x 151.16 MPa) than those for the fracture located at the anterior 25% of the vertebra, and the axial displacement of the 50% fractured body was also greater (1.19 mm x 1.10 mm). Conclusions Coronal split fractures located in the anterior quarter of the vertebral body incurred less stress and displacements and are more amenable to conservative treatment than 50% fractures occurring in the middle of the vertebral body. Level of Evidence III; Experimental study.
Highlights
Coronal split fractures in the thoracolumbar spine can occur through an axial load compression mechanism, separating the vertebra into an anterior and a posterior fragment
Coronal split fractures located in the anterior quarter of the vertebral body incurred less stress and displacements and are more amenable to conservative treatment than 50% fractures occurring in the middle of the vertebral body
In the fracture that occurred in the anterior quarter of the vertebral body, the greatest stress value was observed in the facet joints of vertebra L2
Summary
Coronal split fractures in the thoracolumbar spine can occur through an axial load compression mechanism, separating the vertebra into an anterior and a posterior fragment. These fractures can present varying degrees of instability to compression force, depending on the extension of the vertebral body injury, the same occurring with stability to flexion forces, which can be maintained or reduced, depending on the degree of the injury. The fractures are characterized by injuries of the superior disc, compression fractures, fracture of the superior terminal plate, and coronal fracture of the vertebral body. It is possible to treat these coronal split fractures conservatively, through rest and the use of immobilizing orthoses until consolidation occurs, or surgically through fixation of the vertebral segment with pedicle screws.[1,2,3]
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