Citation

Ragel BT, Allred CD, Brevard SB, Davis RT, Frank EH. Spine 2009; 34(22): 2400-2405.

Affiliation

Department of Neurosurgery, David Grant Medical Center, Travis Air Force Base, CA, USA. brian.ragel@gmail.com

Copyright

(Copyright © 2009, Lippincott Williams and Wilkins)

DOI

10.1097/BRS.0b013e3181b7e585

PMID

19789468

Abstract

STUDY DESIGN: Retrospective analysis. OBJECTIVE: 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). SUMMARY OF BACKGROUND DATA: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Language: en