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Upper thoracic spinal fractures in trauma patients - a diagnostic pitfall
E J van Beek1, H D Been, K K Ponsen
1Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands. e.vanbeek@sheffield.ac.uk
Injury
|March 17, 2000
Summary
Diagnosing upper thoracic spinal fractures in trauma patients is difficult. Early detection requires high suspicion, as standard imaging may miss these injuries, necessitating advanced scans like CT or MRI for accurate diagnosis.
Area of Science:
- Orthopedics
- Radiology
- Trauma Surgery
Background:
- Upper thoracic spinal fractures are challenging to diagnose in multiple-trauma patients.
- Clinical findings are often obscured by other injuries or interventions like respiratory support.
Purpose of the Study:
- To evaluate the diagnostic findings of chest radiographs and plain spinal films for upper thoracic spinal fractures in multiple-trauma patients.
- To assess the missed diagnosis rate and identify key radiographic indicators.
Main Methods:
- Retrospective review of radiographs from 23 patients with upper thoracic spinal fractures.
- Fracture classification using Magerl system (excluding A1, A2 types).
- Neurological outcome assessment using the Frankel scale.
Main Results:
- Initial diagnosis was missed in 22% of patients, primarily due to life-threatening concomitant injuries.
- Common radiographic findings included vertebral height loss (21), widened paraspinal line (21), and widened mediastinum (4).
- Neurological deficits were predominantly Frankel A (14 patients).
Conclusions:
- Upper thoracic spinal fractures are frequently missed in polytrauma settings.
- Advanced imaging (CT/MRI) is crucial for patients with neurological symptoms once stable.