Fracture of one or more parts of the spinal column (vertebrae) of the middle (thoracic) or lower (lumbar) back is a serious injury usually caused by high-energy trauma like a car crash, fall, sports accident or act of violence (i.e., gunshot wound). Males experience the injury four times more often than females do. The spinal cord may be injured depending on the severity of the fracture. Symptoms include:

• Moderate to severe back pain made worse by movement.
• In some cases when the spinal cord is also involved, numbness, tingling, weakness or bowel/bladder dysfunction.

When you fracture the thoracic and lumbar spine, surgery or bracing is often necessary. Often, patients also have other life-threatening injuries. People with osteoporosis, tumors or other underlying conditions that weaken bone can get a spinal fracture with minimal trauma or normal activities of daily living. This is often called a compression fracture.

Classification

Doctors classify fractures of the thoracic and lumbar spine based upon pattern of injury:

• Compression fracture—While the front (anterior) of the vertebra breaks and loses height, the back (posterior) part of it does not. This type of fracture is usually stable and rarely associated with neurologic problems.
• Axial burst fracture—You lose height on both the front and back of the vertebra in this type of fracture, often caused by a fall from height in which you land on your feet.
• Flexion/distraction (chance) fracture—The vertebra is literally pulled apart (distraction), such as in a head-on car crash in which the upper body is thrown forward while the pelvis is stabilized by a lap seat belt.
• Transverse process fracture—This type of fracture results from rotation or extreme sideways (lateral) bending and usually does not affect stability.
• Fracture-dislocation—This is an unstable injury involving bone and/or soft tissue in which one vertebra may move off the adjacent one (displaced).

Treatment

Treatment goals include protecting nerve function and restoring alignment and stability of the spine. The doctor determines the best treatment method based upon fracture type and other factors.

Nonsurgical—Doctors usually treat compression and some burst fractures without surgery. If you have a simple compression fracture, you may need to wear a hyperextension brace for sitting and standing activities for 6-12 weeks. You should walk and do other exercises while healing and may take medication for pain. If you have a transverse process fracture, you may need to wear a thoracolumbar corset along with doing an aerobic walking program.

Surgical—Some injuries require more aggressive treatment. You may need steroids if the spinal cord is injured. You may need surgery if you have an unstable burst fracture, flexion-distraction injury or fracture-dislocation. Surgery realigns the spinal column and holds it together using metal plates and screws (internal fixation) and/or spinal fusion.

Simple rib fractures are one of the most common injuries sustained following blunt chest trauma. They also account for more than half of thoracic injuries from non-penetrating trauma. Approximately 10% of all patients admitted after blunt chest trauma have one or more rib fractures. These fractures are rarely life threatening when seen by themselves, but can be an external marker of more severe internal injuries to the abdomen, chest, and lungs.

Causes

• A direct blow to the rib, otherwise known as blunt chest trauma
• Crushing of the chest—in minor cases this can occur in contact sports or in major cases this occurs in a car accident
• Severe coughing incidents that can occur with lung problems or at high altitude

Signs and Symptoms

• Chest Pain
• Breathing Difficulties
• Pain with Movement
• Swelling of the Ribs
• Bruising of the Ribs

Diagnosis

The doctor will ask about your symptoms, how the injury occurred, and examine your chest, lungs and back.

Tests may include:

• Chest X-ray—An X-ray of the chest to check for fractures and any lung damage
• CT Scan—A type of X-ray that uses a computer to take pictures of structures/organs inside the chest
• MRI Scan—A test that uses magnetic waves to take pictures of structures/organs inside the chest

Treatment

• Rest—Your orthopaedic physician will likely recommend continued rest from any strenuous activity for up to 6 to 8 weeks, depending on the severity of your case.
• Protection—Your orthopaedic physician may also suggest wearing a chest binder around your ribs to protect them and help you breathe properly. It is important that you continue to take good breaths so that the lungs remain clear of fluids. If you play contact sports, your physician may recommend that you wear a rib cage protector for when you return to activity.
• Medication—Your doctor may recommend that you take one of the following anti-inflammatory drugs to help reduce inflammation and pain:
  • Ibuprofen
  • Naproxen
  • Acetaminophen
  • Aspirin
• Physical Therapy—One of the most important parts of your recovery. As your ribs heal, your physical therapist will teach you breathing exercises to keep your lungs fully functioning. Your physical therapy physician will also help you with a customized rehabilitation plan to maintain range of motion in your arm and shoulder joints, and to reestablish your core muscles for stability.
• Hospitalization—If the rib fracture that you experience is accompanied by other injuries and/or damage to your internal organs and tissues, your doctor will likely require you to be treated with long-term hospitalization.