Multiple Adjacent Isolated Thoracic Spinous Process Fractures in High-Energy Trauma.

Jacob M Kirsch,Amit Nathani,Rakesh D Patel

doi:10.1155/2015/921526

Jacob M Kirsch, Amit Nathani + Show 1 more

Open Access

https://doi.org/10.1155/2015/921526

Copy DOI

Abstract

Isolated thoracic spinous process fractures involving multiple adjacent vertebral segments are a rare occurrence in the setting of high-energy trauma. These findings should prompt further investigation to exclude other concomitant osseous or ligamentous injuries. Evaluation by computed tomography is often most useful to detect these fractures. Proper treatment of extensive multilevel injury is poorly defined in the literature. In our experience, conservative management consisting of initial bracing with graduated lifting restrictions has produced excellent functional results.

Highlights

The term “Clay-Shoveler’s fracture” was originally coined in 1940 to describe isolated spinous process fractures occurring from C6-T3 in Western Australian laborers [1]
We report two cases that presented to our institution over the past year of contiguous isolated thoracic spinous process fractures occurring in the setting of high-energy trauma
The patient was initially placed in a thoracolumbar sacral orthosis (TLSO) brace with 5-pound lifting restrictions for 6 weeks; after which time the brace was discontinued and he was increased to 25-pound lifting restrictions

Summary

Introduction

The term “Clay-Shoveler’s fracture” was originally coined in 1940 to describe isolated spinous process fractures occurring from C6-T3 in Western Australian laborers [1]. This fracture pattern has been observed in a variety of patients, including football players, power-lifters, golfers, and trauma patients [2,3,4,5,6]. There have been only three previous reports in the literature documenting isolated thoracic spinous process fractures involving five or more contiguous vertebrae [2, 5, 7]. We report two cases that presented to our institution over the past year of contiguous isolated thoracic spinous process fractures occurring in the setting of high-energy trauma

Case Discussion

Discussion