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SA Orthopaedic Journal

On-line version ISSN 2309-8309
Print version ISSN 1681-150X

SA orthop. j. vol.11 n.3 Centurion Jan. 2012

 

Reprint requests:
Dr Adele Visser
Private Bag x1 Suite 22
0121 Queenswood Pretoria
Cell: +2782 780 1051 Fax: +2712 329 7777
Email: adele.vis@gmail.com

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CLINICAL ARTICLE

 

Proximal thoracic spine fractures: a dangerous blind spot

 

 

D HugoI; RN DunnII

IDr. MBChB(US), MPhil(Sports Med)(UCT) Registrar, Department of Orthopaedics, University of Stellenbosch
IIProf MBChB(UCT), FCS(SA)Orth, MMed(Orth) Associate Professor and Head of Spinal Services: Groote Schuur Hospital, Division of Orthopaedic Surgery, University of Cape Town, South Africa

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ABSTRACT

INTRODUCTION: The proximal thoracic spine is difficult to visualise on X-ray investigation with up to 22% of proximal fractures being missed. This is a major concern, especially in environments such as South Africa where trauma is endemic.
AIM: To review the challenges of diagnosis and management in patients with proximal thoracic fractures.
METHODS: Thirty-three patients with proximal thoracic fractures in the T1-T4 area managed in a spinal unit were identified. There were 21 males and 12 females with a median age of 31.8 years.
A retrospective review of medical records and radiology was undertaken.
Demographic data, mechanism of injury, diagnostic modalities, diagnostic delay, fracture characteristics, neurological status, associated injuries, hospital stay, management, complications and outcomes were recorded.
RESULTS: The aetiology was 21 MVA passengers, eight drivers, one pedestrian, one assault, one bicycle and one hangglider accident. Eight had a one-day diagnostic delay, two between 2 to 5 days and five greater than 2 weeks. The fractures were A1 in seven, A3 in 14, B1 in seven, C1 in two and C2 in two. Twenty-three patients had neurological compromise, 13 being complete. Twentythree had associated chest and head injuries.
Hospital stay was a mean of 27 days (max of 246). ICU median was 14 (max of 115) days.

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