Fractures of the thoracolumbar spine sustained by soldiers in vehicles attacked by improvised explosive devices.
METHODS
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).


BACKGROUND
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).


CONCLUSIONS
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.
Department of Neurosurgery, David Grant Medical Center, Travis Air Force Base, CA, USA. brian.ragel@gmail.com
Brian T
BT
Ragel
C Dain
CD
Allred
Sid
S
Brevard
Richard T
RT
Davis
Edmund H
EH
Frank
D000007:Abdominal Injuries / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D000063:Accidents, Traffic; D000328:Adult; D000346:Afghanistan; D001753:Blast Injuries / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D053834:Explosive Agents / Q000009:adverse effects*; D050815:Fractures, Compression / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D006772:Hospitals, Military; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008889:Military Personnel; D009104:Multiple Trauma; D016103:Spinal Fractures / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D013314:Stress, Mechanical; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000473:pathology / Q000503:physiopathology; D014857:Warfare
D053834:Explosive Agents