Noncontiguous unstable spine fractures

Study Design. Evaluation of 1054 patient charts and 100 random roentgenogram charts as well as clinical investigation of 39 patients. Objectives. Noncontiguous unstable spine fractures are rare, easy overlooked, and difficult to treat. The purpose of the study was to evaluate the delay in diagnosis and clinical and radiologic outcome of these fractures. Summary of Background Data. Noncontiguous spine fractures are reported in about 1.6-16.7% in the literature. In most of the studies stable fractures, which did not need any special treatment, were also included. Therefore, in this study only unstable fractures requiring treatment were reinvestigated. Methods. A total of 1054 patients with fractures of the spine were treated over a period of 14 years in the spinal cord injury unit and retrospectively reviewed; 141 (13.4%) of the patients had multiple fractures, but only 39 (3.7%) had a noncontiguous spine fracture, most frequently from a fall or jump from a greater height, or traffic accidents. Results. Thirty patients (76.9%) had all fractures diagnosed at the first examination. Nine patients (23.1%) had a delayed diagnosis of the secondary lesion, but this delay resulted in no neurologic deterioration. A total of 32 extraspinal injuries were diagnosed and treated 14 times surgically. Loss of correction was seen after surgical treatment (n = 21), and increasing deformity occurred after conservative treatment (n = 18). The neurologic deficit improved in 10 conservatively (4) and operatively (6) treated patients and deteriorated in one patient after surgery. Conclusion. A delayed diagnosis of the second fracture was frequently seen without clinical consequences, and neurologic improvement occurred after conservative and operative treatment. Surgical treatment resulted in significantly earlier mobilization and less kyphotic deformity.