A spinal fracture = break in one or more vertebrae. ⚡ Causes: trauma, osteoporosis, or pathological processes (tumour, infection). They range from minor wedge fractures → unstable cord-threatening injuries needing urgent surgery.

🔑 Key Causes

Trauma 🚗: High-energy trauma (RTA, falls, sports).
Osteoporosis 🧓: Vertebral compression fractures, especially thoracolumbar junction.
Pathological 🦠: Bone weakened by tumour, metastases, infection (osteomyelitis, TB).

🩺 Clinical Presentation

Pain: Severe focal back/neck pain, worse with movement.
Neurological: Tingling, weakness, paralysis if cord/nerve compression.
Deformity: Kyphosis, loss of height, malalignment.
Mobility: Reduced activity, difficulty walking, fear of movement.

📸 Imaging

🩻 X-ray: First-line; must include C7/T1 in cervical trauma.
💻 CT: Best for bony detail; standard in trauma protocols.
🖥 MRI: Essential if neuro deficits, cord oedema, ligamentous injury, tumour suspected.

📊 Classification of Spinal Fractures

Type	Location	Common Causes	Features	Treatment
Odontoid Peg (dens) fracture	C2 (axis)	Falls in elderly, high-energy trauma in young	Neck pain, restricted movement; unstable if type II (base of dens)	Rigid collar/halo vest if stable; surgery (screw fixation/fusion) if unstable
Hangman’s fracture	C2 pars interarticularis	Hyperextension injuries (RTA, falls, hanging)	Anterior slip of C2 on C3; may be unstable	Collar or surgical fixation depending on displacement
Compression fracture	Thoracic/Lumbar	Osteoporosis, minor trauma	Wedge collapse, pain, kyphosis	Conservative (brace, analgesia)
Burst fracture	Thoracolumbar (T12–L2)	High-energy axial load (falls, RTAs)	Fragments retropulsed into canal → neuro risk	Surgical stabilisation if unstable/neuro deficit
Chance fracture	Thoracolumbar (T12–L2)	Flexion–distraction, seatbelt injury	Horizontal fracture through vertebra, possible bowel injury	Surgery usually required
Fracture–dislocation	Any level	Severe high-energy trauma	Vertebral misalignment, severe neuro deficits	Surgical emergency 🚨
Pathological fracture	Any level	Metastases, myeloma, infection	Minimal trauma, persistent pain, collapse	Treat cause + stabilisation
Spondylolysis / spondylolisthesis	L5/S1	Stress fracture (athletes), degenerative	Back pain, step deformity, may compress roots	Physio, bracing; surgery if severe slip

💊 Management Principles

Conservative 🛏️: Stable fractures, no neuro signs → brace, analgesia, physio.
Surgical 🛠: Unstable, neuro deficit, progressive deformity → decompression, fusion, vertebroplasty/kyphoplasty (for osteoporotic fractures).
Rehabilitation 🤸: Multidisciplinary – physio, OT, psychological support, VTE prophylaxis, bone health optimisation (bisphosphonates, vitamin D, calcium).

🎯 Exam Pearls

Odontoid peg fractures common in elderly falls → high non-union risk in type II.
Hangman’s fracture = C2 pars → hyperextension (RTA, hanging).
Compression = stable; Burst = unstable if canal compromise.
Chance fracture = “lap belt injury”, often with bowel perforation.
Always check for neurology + bladder/bowel symptoms in any spinal fracture.

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Spinal Fracture