Fracture-Dislocation of the Upper Thoracic Spine without Neurologic Associated Injury: Two Cases Report

Upper thoracic fractures are produced by high-energy trauma. Fracture-dislocation (type C Association) for the Study of Internal Fixation (AO classification) of the upper thoracic spine represents 15% of all thoracic and lumbar fractures. The neurological injury occurs in 80% of cases, being extremely rare type C fractures without spinal cord injury. We report a case of 51 years-old male with no past medical history, who was brought to our Hospital after falling from a 10 meters high roof. He had 15 points at Glasgow Coma Scale (GCS) and a completely normal neurological examination. A whole body computerized tomography (CT) scan was performed and diagnosed a fracture-dislocation at T8-T9. Acute surgery was decided, performing an open reduction and internal fixation with pedicle screws from T6 to T1. Clinical outcome was favorable. The second case is a 29 years old patient, who suffered a motorcycle accident. On arrival at critics room presented 14 points at GCS and American Spinal Injury Association scale (ASIA) E. After whole CT scan, was diagnosed a T10 fracture-dislocation, an open left iliac fracture, open right distal tibia fracture and a fracture of 10th left costal arch. Acute surgery was decided: performing external fixation of right tibia, wound cleaning and exploration of iliac crest and open reduction and fixation of the fracture-dislocation of thoracic spine. After nine days from the first surgery an open reduction and internal fixation (ORIF) of the right distal tibia was performed and a closed reduction and internal fixation (CRIF) of tibial plateau fracture. Ligamentoplasty of anterior cruciate ligament (ACL) of the right knee was also done arthroscopically. Clinical outcome was satisfactorily. The fracture-dislocation of the upper thoracic spine is often associated with spinal cord injury, there is a very few reported cases in bibliography without neurological damage. The initial clinical management of this patients is crucial at critics room, Advanced Trauma Life Support (ATLS) must be applied and subsequently perform a damage control. In patients with upper thoracic fracturedislocation without spinal cord involvement, immediate reduction and osteosynthesis should always be performed.

[1]  Safa T. Herfat,et al.  Integrity of Damage Control Posterior Spinal Fusion Constructs for Patients With Polytrauma: A Biomechanical Investigation , 2015, Spine.

[2]  C. Bruno,et al.  The injury pattern in fatal suicidal falls from a height: an examination of 307 cases. , 2014 .

[3]  Bing Jiang,et al.  Severe thoracic spinal fracture-dislocation without neurological symptoms and costal fractures: a case report and review of the literature , 2014, Journal of Medical Case Reports.

[4]  S. Katoh,et al.  Surgical Treatment for Significant Fracture-dislocation of the Thoracic or Lumbar Spine without Neurologic Deficit: A Case Series , 2014, Journal of orthopaedic case reports.

[5]  G. Yoshida,et al.  Range of motion of thoracic spine in sagittal plane , 2014, European Spine Journal.

[6]  E. Moore,et al.  The impact of a standardized “spine damage-control” protocol for unstable thoracic and lumbar spine fractures in severely injured patients: A prospective cohort study , 2013, The journal of trauma and acute care surgery.

[7]  E. Bulger,et al.  Upper thoracic spine fracture dislocation in a motorcyclist. , 2012, Current problems in diagnostic radiology.

[8]  M. Djuric,et al.  Pontomedullary Lacerations in Falls from a Height—A Retrospective Autopsy Study * , 2012, Journal of forensic sciences.

[9]  C. Heyde,et al.  ATLS® and damage control in spine trauma , 2009 .

[10]  S. Boriani,et al.  Case report of complete dislocation of T1–T2 without neurological deficit and review of the literature , 2005 .

[11]  E. Vialle,et al.  Thoracic spine fractures. , 2005, Injury.

[12]  W. Castro,et al.  Thoracic fracture-dislocations without spinal cord injury: a case report and literature review , 2004, European Spine Journal.

[13]  J. Wilson-Macdonald,et al.  Thoracic fracture dislocations without vertebral clinical signs. , 2003, Injury.

[14]  S. Shapiro,et al.  Traumatic thoracic spinal fracture dislocation with minimal or no cord injury. Report of four cases and review of the literature. , 2002, Journal of neurosurgery.

[15]  J. Abril,et al.  Fracture-dislocation of the thoracic spine without neurological lesion. , 1994, Injury.

[16]  T. Hayashi,et al.  Posterior fracture-dislocation of the thoracic spine without neurologic deficit. A case report and short literature review. , 1993, Spine.

[17]  P. Krallis,et al.  [Fracture-dislocation of the dorsal spine with severe displacement without neurologic impairment: Case presentation and literature review]. , 1992, Acta orthopaedica Belgica.

[18]  A. Simpson,et al.  Thoracic spine translocation without cord injury. , 1990, The Journal of bone and joint surgery. British volume.

[19]  B. Elguezabal,et al.  Fracture-dislocation of the thoracic spine without neurologic lesion. , 1987, Clinical orthopaedics and related research.

[20]  A. Sasson,et al.  Complete fracture-dislocation of the thoracic spine without neurologic deficit. A case report. , 1987, Spine.

[21]  D. Harryman.  Complete fracture-dislocation of the thoracic spine associated with spontaneous neurologic decompression. A case report. , 1986, Clinical orthopaedics and related research.

[22]  S. Weber,et al.  An unusual rotational fracture-dislocation of the thoracic spine without neurologic sequelae internally fixed with a combined anterior and posterior approach. , 1986, The Journal of trauma.

[23]  Y. Tropet,et al.  [Complete fracture-dislocation of thoracic vertebrae 8 and 9 without neurological complications. Description of the injury. Therapeutic deductions]. , 1983, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur.

[24]  S. Gertzbein,et al.  Complete fracture-dislocation of the thoracic spine without spinal cord injury. A case report. , 1979, The Journal of bone and joint surgery. American volume.