Wedge Compression Fracture

1. Spine Case # 3

2. History and Physical 85 yo elderly female presents to ED w/ neck pain after single car mvc . Pt lost control striking tree at 45 mph. Denies LOC. Short extrication from vehicle. Pt c/o minor diffuse pain. No gross abnormalities. T 98.7 P 78 BP 115/68 O2 98% RA RR 18 Gen: WDWN, mild distress HEENT: bruising to face, PERRL, EOMI Back: mild midline cervical tenderness, no bony abnormalities or step offs Neuro : 5/5 strength throughout, pt moves all extremities well

3. Cervical spine radiograph Copyright © 2009 Heidi & David Nunn http://imageinterpretation.co.uk/cervical.html

4. Diagnosis: Wedge compression fracture Description compression fracture resulting from flexion. Mechanism Anterior or lateral flexion causing failure of anterior column Radiographic features Buckled anterior cortex. Loss of height of anterior vertebral body. Anterosuperior fracture of vertebral body. Stability stable © 2000 by the Rector & Visitors of the University of Virginia http://www.med-ed.virginia.edu/courses/rad/cspine

5. Non-operative Pain management Early ambulation in hyperextension orthosis Avoidance of compression overloads for 12 wks as an outpt http://www.wheelessonline.com/ortho/compression_fractures ED Management

6. Amount of anterior compression should be no more than 40% relative to posterior body height (otherwise a burst fx may be present) http://www.wheelessonline.com/ortho/compression_fractures Clinical Pearls