Answer
1) plain radiograph shows
- This is a lateral lumbosarcral view
- There is a compression fracture of the L4 with loss of ½ of the vertebral body
- No lytic or sclerotic lesion seen on the spine.
2) Mechanism of injury
- In osteoporotic patient who slip and land on their bottom
- Young patient who fall from height and land on their heels (look at the calcaneal to see fracture)
- Pilot who eject from jet aircraft due to upward force of the rockets in the ejector seat crush the vertebra.
- Fracture in TB spine due to collapse of the vertebra.
3) Question to ask or info to obtain
- Age and gender of the patient
- Other fracture like distal radius or neck of femur (osteoporosis)
- History of fall on the buttock
- Fall from height and land on heels
- Any contact with TB patient
4) Deformity can be accepted and no need treatment unless more than 50% collapse of vertebra body (distraction and internal fixation may be needed)
+ Analgesic depending on patient requirement. May give simple analgesic such as NSAIDs (ibuprofen, mefenamic acid, diclofenac acid) but some patient may require opioid if there is co-existing nerve compression or slipped disc.
Bed rest
Neurological evaluation. If abnormal, patient may require MRI of the spine to confirm the pathology
1) plain radiograph shows
- This is a lateral lumbosarcral view
- There is a compression fracture of the L4 with loss of ½ of the vertebral body
- No lytic or sclerotic lesion seen on the spine.
2) Mechanism of injury
- In osteoporotic patient who slip and land on their bottom
- Young patient who fall from height and land on their heels (look at the calcaneal to see fracture)
- Pilot who eject from jet aircraft due to upward force of the rockets in the ejector seat crush the vertebra.
- Fracture in TB spine due to collapse of the vertebra.
3) Question to ask or info to obtain
- Age and gender of the patient
- Other fracture like distal radius or neck of femur (osteoporosis)
- History of fall on the buttock
- Fall from height and land on heels
- Any contact with TB patient
4) Deformity can be accepted and no need treatment unless more than 50% collapse of vertebra body (distraction and internal fixation may be needed)
+ Analgesic depending on patient requirement. May give simple analgesic such as NSAIDs (ibuprofen, mefenamic acid, diclofenac acid) but some patient may require opioid if there is co-existing nerve compression or slipped disc.
Bed rest
Neurological evaluation. If abnormal, patient may require MRI of the spine to confirm the pathology