Fractures of the Thoracolumbar Spine Sustained by Soldiers in Vehicles Attacked by Improvised Explosive Devices

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2009-10, Vol.34 (22), p.2400-2405
• Main Authors: RAGEL, Brian T, DAIN ALLRED, C, BREVARD, Sid, DAVIS, Richard T, FRANK, Edmund H
• Format: Article
• Language: English
• Subjects: Abdominal Injuries - etiology; Abdominal Injuries - pathology; Abdominal Injuries - physiopathology; Accidents, Traffic; Adult; Afghanistan; Biological and medical sciences; Blast Injuries - complications; Blast Injuries - pathology; Blast Injuries - physiopathology; Cerebrospinal fluid. Meninges. Spinal cord; Diseases of the osteoarticular system; Diseases of the spine; Explosive Agents - adverse effects; Fractures, Compression - etiology; Fractures, Compression - pathology; Fractures, Compression - physiopathology; Hospitals, Military; Humans; Lumbar Vertebrae - injuries; Lumbar Vertebrae - pathology; Lumbar Vertebrae - physiopathology; Male; Medical sciences; Military Personnel; Multiple Trauma; Nervous system (semeiology, syndromes); Neurology; Spinal Fractures - etiology; Spinal Fractures - pathology; Spinal Fractures - physiopathology; Stress, Mechanical; Thoracic Vertebrae - injuries; Thoracic Vertebrae - pathology; Thoracic Vertebrae - physiopathology; Warfare
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0b013e3181b7e585

Retrospective analysis. To analyze the types of orthopedic spine fractures sustained by North Atlantic Treaty Organization soldiers when vehicles are attacked by improvised explosive devices (IEDs), with specific focus on the flexion-distraction type thoracolumbar fracture (Chance fracture). Operation Enduring Freedom is the North Atlantic Treaty Organization's effort in Afghanistan. IED attacks on armored vehicles are common and account for high proportion of soldiers' deaths and injuries. Retrospective record review was accomplished on soldiers admitted to a military hospital with orthopedic spine fractures after IED attacks on vehicles from January 1, 2008 to May 15, 2008. Thoracolumbar fractures were classified using the McAfee classification system. Twelve male patients with 16 thoracolumbar fractures were identified (3 patients with multiple fractures). The 16 thoracolumbar fractures included 6 flexion-distraction fractures in 5 patients (38%, 6/16: two T12, two L1, one L3, and one L4), 7 compression fractures in 5 patients (44%, 5/16; one T7, one T8, two L1, one L2, one L3, and one L4), and 3 burst fractures (19%, 3/16; two L1 and one L2). The incidence of flexion-distraction thoracolumbar (Chance) fractures has been reported to be between 1.0% and 2.5% in most spine fracture series. In this small study, Chance fractures represented 38% of all tho-racolumbar fractures sustained after IED attack on armored vehicles. The blast pattern associated with IED explosion may be responsible for the high rate of these injuries in vehicle occupants.