Thoracic Fracture-dislocation Research Articles

Thoracic Fracture-Dislocations without Neurologic Injury: 2 Cases Report and their Literature Review

Thoracic Fracture-Dislocations without Neurologic Injury: 2 Cases Report and their Literature Review

Severe Lateral Thoracic Fracture-Dislocation without Neurological Deficit – Case Report

Introduction A case report of a thoracic fracture-dislocation (T11–T12) without neurological deficit is presented. Objective Report the diagnosis and treatment of a traumatic severe fracture with lateral dislocation at the thoracolumbar junction without neurological deficit. Background Fracture-dislocation of the thoracic spine without neurological deficit is a rare lesion. We retrieved only 15 cases reported in the literature. Surgical treatment with spinal decompression, fusion and realignment is the treatment of choice. Case A 40-year-old man suffered a bicycle accident and was admitted with severe back pain but neurologically intact. He was treated with a wide laminectomy and spinal cord decompression followed by correction of his deformity using pedicle screw instrumentation and rod maneuvers. Results After three days, the patient was able to walk, and after one month he had just mild back pain, but was neurologically intact, and was able to return to his usual daily activities. After six months, he was neurologically intact and performing routine physical activities. Conclusions Fracture-dislocation of the thoracic spine without neurological deficit is a rare injury. A good outcome can be obtained with modern spinal stabilization surgical techniques, avoiding late neurological deterioration.

Paraplegia caused by thoracic fracture dislocation in a young patient and management: case report

Paraplegia caused by thoracic fracture dislocation in a young patient and management: case report

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

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.

Late Occurrence of Traumatic Chylothorax in a Multi-Trauma Patient With a Thoracic Spine Fracture-Dislocation

Chylothorax is a rare form of chyle accumulation that can be associated with both traumatic and non-traumatic causes. We described a case of a patient who sustained a thoracic spine fracture-dislocation and presented with a left-sided chylothorax as a late complication to his thoracic spine trauma. A 19-year-old multi-trauma patient with bilateral pneumothorax, bilateral lung contusions and a severe thoracic spine fracture-dislocation was admitted to the intensive care unit (ICU) of our hospital intubated due to his unstable respiratory function. Bilateral thoracostomies were placed to his thoracic cavity prior to his admission to the ICU. The thoracic fracture-dislocation was stabilized with posterior fixation of his thoracic spine during his stay at the ICU. He was transferred to the neurosurgery department where at the 50th day of his hospitalization, a left-sided chylothorax was identified. Conservative management was decided and the chyle leak ceased over a period of 2 weeks. The patient was discharged from the clinic after a 3-month period of hospitalization. Traumatic chylothorax is a rare complication directly linked to thoracic spine fractures. It can occur immediately after trauma or several weeks after as in our case. Early diagnosis and treatment are essential for the avoidance of severe complications linked to the chyle loss. J Med Cases. 2015;6(12):568-571 doi: http://dx.doi.org/10.14740/jmc2364w

Letter to the Editor: Thoracic fracture-dislocations

Letter to the Editor: Thoracic fracture-dislocations

Treatment of subacute thoracic spine fracture-dislocation by total vertebrectomy and spine shortening

Vertebral resection with spine shortening has been primarily reported for the treatment of demanding cases of nontraumatic disorders. Recently, this technique has been applied to the treatment of traumatic disorders. The current treatment of vertebral fracture-dislocation when there is partial or total telescoping of the involved vertebrae is a combined anterior-posterior approach with corpectomy, anterior support implant, and further posterior instrumentation. These procedures usually require 2 surgical teams, involve longer operating times and greater risk of surgical complications related to the anterior approach, and commonly entail longer postoperative care before discharge. The authors report on 2 patients with high thoracic fracture-dislocations with telescoping (T-2 and T-4) who were treated in the subacute phase with total spondylectomy (T-3 and T-5, respectively) and spine shortening by using only a posterior approach. Complete recovery of the sagittal balance was achieved with this technique and the postoperative periods were clinically uneventful. One patient presented with asymptomatic hemothorax that did not require drainage. In paraplegic patients with anterior thoracic dislocation fractures in which one vertebral body blocks the reduction of the other, total spondylectomy and spine shortening seem to be a reasonably safe and effective technique.

Bacterial Meningitis After Traumatic Thoracic Fracture-Dislocation: Two Case Reports and Review of the Literature

Bacterial meningitis occurs rarely in the setting of traumatic spinal injury. Bacterial meningitis after spinal surgery for traumatic thoracic fracture-dislocation injuries has not been reported. We report on two cases of bacterial meningitis in two pediatric patients undergoing posterior segmental instrumentation with pedicle screws after thoracic fracture-dislocation injuries with associated traumatic dural laceration and complete spinal cord transection. Both patients were treated and recovered. Early recognition of bacterial meningitis after traumatic spinal injury enables appropriate and timely treatment to be instituted and can yield a favorable outcome.

Air in the spinal canal associated with trauma

Air in the spinal canal after trauma is uncommon. We report a case of a motor vehicle accident resulting in a thoracic fracture-dislocation. Air was discovered within the spinal canal on a computed tomography (CT) scan. This injury pattern proved to be a diagnostic dilemma because multiple etiologies existed. Pneumothorax, ruptured esophagus, facial sinus fractures, and herniated vertebral discs can result in this entity.

Thoracic Fracture-Dislocations Without Spinal Cord Injury - Two Cases Reports-

Thoracic fracture-dislocations reportedly lead to an 80% incidence of complete paraplegia. Thus, thoracic fracture-dislocations without cord injury are uncommon. There are a few cases of thoracic fracture-dislocations in which the neural sparing status was associated with separation of the posterior spinal structures, such as the pedicles and laminae. The authors experienced two cases of thoracic fracture-dislocations without spinal cord injury: one was a 50-year-old man who fell from the fourth floor of a building and sustained a T6-7 fracturedislocation; and the other was a 43-year-old man who was involved in motorcycle accident and sustained a T12 fracture-dislocation. Segmental spinal instrumentation and fusion without open reduction was performed in each of the two cases and there has not been any abnormality detected on neurological examination at a minimum follow-up period of 2 years.

Thoracic fracture-dislocation without spinal cord injury: case report and literature review

Summary Fracture-dislocations of the spine represent the most unstable spinal injury, and they are often associated with severe neurological compromise. We report the case of a patient who was involved in a motorcycle accident, after which, no neurological deficit could be found. A severe fracture-dislocation of T8-T9 was diagnosed. The patient was operatively treated with a T8-T9 corpectomy, placement of an iliac bone graft and stabilization using the Kaneda antero-lateral spinal system. Complete reduction was archieved without neurological sequelae. The injury and neural sparing production mechanisms, as well as, the surgical treatment advantages and indications are discussed.