Thoracic Spine Fracture in the Panscan Era.

Area of Science:

• Traumatology
• Radiology
• Orthopedic Surgery

Background:

• Frequent use of computed tomography (CT) for adult blunt trauma evaluation identifies minor injuries.
• Traditional teachings on thoracic spine fractures may be outdated due to advanced imaging.
• Need to update clinical understanding of thoracic spine fractures in trauma patients.

Purpose of the Study:

• Determine the incidence of thoracic spine fractures detected solely by CT.
• Analyze admission rates, mortality, and hospital length of stay for these patients.
• Assess the clinical significance of thoracic spine fractures.

Main Methods:

• Analysis of prospectively collected data from the NEXUS Chest CT study (2011-2014).
• Inclusion criteria: blunt trauma within 6 hours of ED presentation, age >14 years, chest imaging.
• Data from 9 Level I trauma centers, involving 11,477 subjects.

Main Results:

• 1.9% of subjects (217/11,477) had thoracic spine fractures.
• 91.4% of fractures were CT-only findings.
• Patients with thoracic spine fractures had higher admission rates, mortality, and longer hospital stays.
• However, mortality was similar if no other thoracic injuries were present.
• Less than half (47.4%) of fractures were clinically significant (bracing, surgery, or neurologic deficit).

Conclusions:

• Thoracic spine fractures are uncommon and often diagnosed via CT.
• Associated thoracic injuries, not the fracture itself, are the primary drivers of mortality.
• The majority of thoracic spine fractures are clinically insignificant, with rare instances of surgical intervention or neurologic deficit.