The quadrangular fragment fracture. Roentgenographic features and treatment protocol

The quadrangular fragment fracture is a clinically discrete type of cervical lesion that poses a difficult management problem. Physically, it resembles the triangular fragment fracture or teardrop fracture, but it responds very poorly to posterior fusion, the conventional treatment for these fractures. It is characterized by a quadrangular-shaped fragment from the anterior one-third of the vertebral body, a significant degree of posterior subluxation, an angular kyphosis, and an increased interspinous space with facet subluxation due to disruption of the soft tissues. Recognition of the quadrangular fragment may help determine the treatment protocol. A group of 23 patients with quadrangular fragment fracture was treated with the standard protocol and had poor results, including difficulty in maintaining reduction, neck pain, and significant residual kyphosis. A second group of 15 patients received kyphosis. A second group of 15 patients received the second treatment protocol, which consisted of one to two weeks of skull traction over an extension bolster, followed by an anterior interbody strut graft to stabilize the fracture and further traction over an extension bolster until four weeks postinjury. Treatment minimized the angular kyphosis apparent at bony healing, and all patients achieved satisfactory union with good alignment and no significant neck pain.