title: Unstable fractures of the upper thoracic spine.
abstract: Unstable fractures of the upper thoracic spine are a therapeutic challenge because of the high rate of associated injuries and frequent occurrence of spinal cord lesions. This study focuses on the operative treatment of these injuries. We present nine patients with unstable injuries of the upper thoracic spine. According to the classification of Magerl et al., there are seven type C and two type B fractures. Eight patients had complete transverse lesions of the cord and one had no evidence of spinal cord injury. All patients presented associated injuries: nine patients had fractured ribs, three a fractured sternum and three a severe haemothorax. All underwent operative treatment: six posterior fusions only, two anterior interbody fusions only after thoractotomy owing to severe bleeding from ruptured intercostal arteries, and one a combined fusion after failure of posterior fusion. The treatment of these patients should be individualized, depending on the associated injuries, loss of blood owing to fractured spine and ruptured vessels and depending on the back pain resulting from an unstable thorax. In general, we prefer the posterior approach to unstable fractures of the upper thoracic spine.
authors.affiliation: Department of Traumatology, University of Graz, Austria.
authors.forename: F
authors.initials: F
authors.lastname: Schweighofer
authors.forename: H P
authors.initials: HP
authors.lastname: Hofer
authors.forename: R
authors.initials: R
authors.lastname: Wildburger
authors.forename: N
authors.initials: N
authors.lastname: Stockenhuber
authors.forename: G
authors.initials: G
authors.lastname: Bratschitsch
mesh_terms: D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011859:Radiography; D013119:Spinal Cord Injuries / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery; D016103:Spinal Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery