Thoracic Bony Trauma

Julia Crim, MD

DIFFERENTIAL DIAGNOSIS

Common

Less Common

Trauma and Post-Traumatic Abnormalities
- Fracture-Dislocation, Thoracolumbar Junction
- Distraction Fx, Low Thoracic
- Kümmell Disease
Nontraumatic Fracture Mimics
- Langerhans Cell Histiocytosis
- Scoliosis and Kyphosis, Congenital
- Renal Osteodystrophy
- Achondroplasia
- Osteomyelitis, Granulomatous
- Cushing Disease

ESSENTIAL INFORMATION

Key Differential Diagnosis Issues

Important to distinguish between types of vertebral body fractures since treatment differs by type
Fractures most common at thoracolumbar junction
When one spine fracture is seen, always look for others

Helpful Clues for Common Diagnoses

Anterior Compression Fracture
- Never involves posterior vertebral body cortex or neural arch
- Easily missed in upper T-spine on radiographs
Chance Fracture
- Usually extends through posterior vertebral body cortex, but no retropulsed fragment
- Horizontal fracture of posterior elements OR rupture of interspinous ligaments and facet joints
Burst Fracture
- Always extends through posterior vertebral body cortex, may have retropulsed fragment
- Vertical fracture of posterior elements also present
Scheuermann Disease
- 4 or more levels involved; undulating endplates; normal anterior cortex