title: Isolated transverse process fractures: insignificant injury or marker of complex injury pattern?
abstract: BACKGROUND
  This study investigates the incidence of isolated transverse process fractures (ITPFx) amongst vertebral fractures in trauma patients, and specific-associated injury patterns present in patients with ITPFx.
  
  
  METHODS
  A retrospective, 4-year review of our Level 1 Trauma Center registry was performed. Patients with blunt spinal column fractures were identified. Data collected included patient demographics, Injury Severity Score (ISS), type of imaging obtained, and concomitant injuries, including rib and pelvic fractures, liver, spleen, and kidney injury (SOI).
  
  
  RESULTS
  Of the 10,186 patients admitted during the study period, 881 (8.6%) suffered blunt thoraco-abdominal trauma resulting in vertebral fractures; 214/881 (24%) had ITPFx. All patients (10,186) underwent dedicated spinal multi-detector CT (MDCT) imaging; 26/214 (12.1%) patients had MRI. In all 26 patients, the MRI confirmed the CT findings. 202/214 (94.4%) had associated injuries: rib and pelvic fractures, 45.5 and 20.2%, respectively, and splenic, liver and kidney injury with an incidence of 13.8, 10.9, and 9.4%, respectively. A higher incidence of rib fractures was associated with ITPFx at the T1-4 levels, whereas ITPFx at the level of L5 were associated with pelvic fractures and SOI. Multiple logistic regression analysis identified T1-4 and L5 fractures as predictors of rib fractures and pelvic fractures independent of ISS, with OR: 2.55 (95% CI: 1.12-5.82) and 6.81 (95% CI: 3.14-14.78), respectively.
  
  
  CONCLUSIONS
  Based on the results of this study, we conclude that: (1) the use of MDCT imaging has increased the rate of identification of ITPFx; (2) dedicated spinal MDCT reconstruction and MRI may not be necessary to diagnose isolated thoracic and lumbar ITPFx; and (3) ITPFx of the thoracic spine and lower lumbar spine are markers of associated rib fractures and pelvic ring fractures, respectively, as well as of solid organ injuries.
authors.affiliation: Division of Trauma Surgery, Surgical Critical Care and Acute Care Surgery, Westchester Medical Center University Hospital, 100 Woods Road, Taylor Pavilion, Suite E-145, Valhalla, NY, 10595, USA. Gary.Lombardo@wmchealth.org.
authors.forename: G
authors.initials: G
authors.lastname: Lombardo
authors.affiliation: Department of Surgery New York Medical College, Valhalla, NY, USA.
authors.forename: P
authors.initials: P
authors.lastname: Petrone
authors.affiliation: Division of Trauma Surgery, Surgical Critical Care and Acute Care Surgery, Westchester Medical Center University Hospital, 100 Woods Road, Taylor Pavilion, Suite E-145, Valhalla, NY, 10595, USA.
authors.forename: K
authors.initials: K
authors.lastname: Prabhakaran
authors.affiliation: Department of Surgery New York Medical College, Valhalla, NY, USA.
authors.forename: C P
authors.initials: CP
authors.lastname: Marini
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008159:Lumbar Vertebrae / Q000293:injuries; D008279:Magnetic Resonance Imaging; D008297:Male; D009104:Multiple Trauma; D009518:New York; D012042:Registries; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000293:injuries; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery
keywords: CT; MRI; Marker; Spinal fractures; Transverse process fractures