title: Isolated Transverse Process Fractures: A Systematic Analysis.
abstract: OBJECTIVE
  To review the literature on isolated transverse process fractures (ITPFs) and provide evidence for the current practice of conservative management.
  
  
  METHODS
  The PubMed database was searched for published literature related to ITPFs. Baseline patient (age, sex, presentation, and mechanism of injury) and fracture (number of fractures, level, and single or multisegmental) characteristics were extracted. Management and outcomes were also recorded. Statistical comparisons were ascertained through n-1 Pearson χ2tests.
  
  
  RESULTS
  A total of 4 studies comprised of 398 patients with 819 ITPFs were evaluated. Mean age was 33.5 years (69% men and 31% women). No patients presented with neurologic deficits. The most common mechanism of injury was motor vehicle accident (MVA), followed by fall. MVAs were more commonly the cause of ITPFs in pediatric versus adult patients (88% vs. 65%, respectively; P = 0.0001). Falls were more commonly the cause of ITPFs in adults than in children (18% vs. 9%, respectively; P = 0.05). Management strategies involved unrestricted movement, bracing, and orthotics. Radiologic evidence of spinal instability or deformity was not reported in any of the cases. Mean follow-up was 20.5 months.
  
  
  CONCLUSIONS
  Our data suggests that nonsurgical management of ITPFs leads to complete resolution of the fracture without evidence of permanent neurologic deficit or spinal instability. However, interpretation of our results is limited by the paucity of meaningful literature reporting on long-term outcomes. Nevertheless, the results provide support for conservative management and highlight the existing need to identify markers or scenarios where the diagnosis of ITPF is actually likely to be erroneous.
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Nagasawa
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Timothy T
authors.initials: TT
authors.lastname: Bui
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Carlito
authors.initials: C
authors.lastname: Lagman
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Seung J
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Lawrance K
authors.initials: LK
authors.lastname: Chung
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Tianyi
authors.initials: T
authors.lastname: Niu
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tucker
authors.affiliation: UCLA Comprehensive Spine Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Bilwaj
authors.initials: B
authors.lastname: Gaonkar
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Isaac
authors.initials: I
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA; UCLA Comprehensive Spine Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA. Electronic address: lmacyszyn@mednet.ucla.edu.
authors.forename: Luke
authors.initials: L
authors.lastname: Macyszyn
mesh_terms: D000058:Accidental Falls; D000063:Accidents, Traffic; D000072700:Conservative Treatment / Q000379:methods*; D019468:Disease Management; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D008159:Lumbar Vertebrae / Q000293:injuries*; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*
keywords: Review; Spine trauma; Transverse process fractures