Wedge fracture


Wedge fracture

Description, Causes and Risk Factors:

A wedge fracture is a vertebral compression fracture occurring anteriorly or laterally. Viewed, the affected vertebra resembles a wedge. These fractures are more commonly found in the thoracic spine, which is rather rigid displaying only a few degrees of flexion and extension. Although the thoracic spine does maintain a wide range of torsion (ability to rotate), it responds poorly to movement defined as hyperflexion (beyond normal limits).

In general wedge fractures are stable without neurologic involvement. Wedge fractures are considered serious when the fracture affects adjacent vertebrae, anterior wedging is 50%, severe hyperkyphosis (bent forward) is present, or bone fragment(s) are suspect in the spinal canal. In the latter, symptoms and sign of myelopathy (spinal cord dysfunction) may be present.

Wedge fractures are the most common type of lumbar fracture and are the typical compression fracture of malignancy or osteoporosis. They occur as a result of an axially directed central compressive force combined with an eccentric compressive force. In pure flexion-compression injuries, the middle column remains intact and acts as a hinge. Although wedge fractures are usually symmetric, 8-14% are asymmetric and are termed lateral wedge fractures.

This type of fracture occurs when the applied force is concentrated to the anterior portion of the vertebral body. Wedge fractures are often associated with kyphosis, that is, the bending forward of the spine causing a hunchback appearance in the patient.

In younger patients, fractures are usually due to violent trauma. Car accidents frequently cause flexion and flexion distraction injuries. Jumps or falls from heights cause burst fractures. These fractures can also result in serious neurological injury. In older patients, these fractures usually occur in the absence of trauma, or in the context of minor trauma, such as a fall. The most common underlying reason for these fractures in geriatric patients, especially women, is osteoporosis. Other disorders that can contribute to the occurrence of these fractures include malignancy, infections, and renal disease.

Symptoms:

One or more symptoms can indicate a wedge fracture:

    Sudden, severe back pain (though many times the symptoms can come on gradually and worsen over time).

  • Worsening of pain when standing or walking.

  • Some pain relief when lying down.

  • Difficulty and pain when bending or twisting.

  • Loss of height.

  • Deformity of the spine - the curved, "hunchback" shape.

The pain typically occurs with a slight back strain during an everyday activity, like:

    Lifting a bag of groceries.

  • Bending to the floor to pick something up.

  • Slipping on a rug or making a misstep.

  • Lifting a suitcase out of the trunk of a car.

  • Lifting the corner of a mattress when changing bed linens.

Diagnosis:

Wedge fractures require immediate medical care by a Spine specialist. The physical examination will include a neurological assessment of the patient's motor (function), sensory (sensation), and reflex responses.

Radiographs may include lateral and AP x-rays of the affected spinal segment. The physician may request a CT scan, with (myelography) or without a contrast medium to help identify the fracture type, its status (stable versus unstable), and if fragments have entered the spinal canal.

Further, an MRI may be ordered if soft tissue trauma or hematoma (blood clot) is suspected. The physical and neurological examinations along with the radiographic findings are compared to make the diagnosis.

If osteoporosis is suspected, a BMD (bone mineral density) test may be ordered. This test helps determine the severity of the bone thinning. In addition, laboratory tests to look at blood count and thyroid function may be indicated as well. A decision as to whether to treat osteoporosis should be made by the patients' primary physician.

Treatment:

Wedge fractures affect the height of the vertebral body. This reduction of height is quantified to help the spinal physician determine a course of treatment. If the loss of vertebral height falls in the 10-30% range, the treatment is conservative. This includes bed rest with hyperextension of the affected spinal level for a week to 10 days followed by bracing for 3 to 8 weeks. During bracing, if progress is good after 3 weeks, the patient may be allowed to walk and begin physical therapy.

When the loss is in the 30-50% range, conservative treatment includes traction under radiologic control to reduce the fracture. Following traction, the patient wears a plaster jacket for 45 days followed by a brace for the next 2 months to maintain fracture reduction. Physical therapy follows.

Surgery is indicated when the loss exceeds 50%. Spinal instrumentation and/or fusion can be utilized to restore lost height. Spinal Instrumentation and Fusion can be used to provide permanent stability to the spinal column. These procedures join and solidify the level where a spinal element has been damaged or removed (i.e. intervertebral disc). Instrumentation, the use of medically designed hardware such as rods and screws, can be combined with Spinal fusion (arthrodesis) to permanently join two or more vertebrae.

Prior to release from the hospital, the patient is given written instructions and prescriptions for necessary medication. The patient's care continues during follow-up visits with their spinal specialist.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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