Fractures of the transverse processes of the fourth and fifth lumbar vertebrae in patients with pelvic ring injuries: indicator of biomechanical instability but not shock

• Published in: The bone & joint journal Vol. 100-B; no. 9; pp. 1214 - 1219
• Main Authors: Winkelmann, M, Lopez Izquierdo, M, Clausen, J-D, Liodakis, E, Mommsen, P, Blossey, R, Krettek, C, Zeckey, C
• Format: Journal Article
• Language: English
• Published: England 01.09.2018
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biomechanical Phenomena; Child; Child, Preschool; Female; Hemodynamics; Humans; Injury Severity Score; Lumbar Vertebrae - injuries; Male; Middle Aged; Pelvic Bones - injuries; Retrospective Studies; Spinal Fractures - complications; Trauma Centers; Young Adult; Shock; Emergency treatment; Multiple trauma; Pelvis
• ISSN: 2049-4394; 2049-4408
• DOI: 10.1302/0301-620X.100B9.BJJ-2018-0071.R1

This study aimed to analyze the correlation between transverse process (TP) fractures of the fourth (L4) and fifth (L5) lumbar vertebrae and biomechanical and haemodynamic stability in patients with a pelvic ring injury, since previous data are inconsistent. The study is a retrospective matched-pair analysis of patients with a pelvic fracture according to the modified Tile AO Müller and the Young and Burgess classification who presented to a level 1 trauma centre between January 2005 and December 2014. A total of 728 patients with pelvic ring injuries were included, of whom 183 (25.1%) had a biomechanically unstable pelvic fracture. Of these patients, 84 (45.9%) had a fracture of a TP of L4 and/or L5. A total of 73 patients (13.4%) with a stable pelvic ring injury (p < 0.001) had a fracture of a TP. Patients with a fracture of a TP of L4 and/or L5 had a 5.5-fold risk (odds ratio (OR)) of having a biomechanically unstable pelvic injury. TP fractures (OR 1.6, p = 0.2) could not be confirmed as an independent predictor of haemodynamic instability. This is the first study that has demonstrated a positive correlation between a TP fracture of L4 and/or L5 and a biomechanically unstable pelvic ring injury. The presence of transverse process fractures of L4 and/or L5 indicates increased severity of pelvic injury and therefore can help in the planning of emergency treatment. Cite this article: Bone Joint J 2018;100-B:1214-19.