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

Brian T. Ragel, C. Dain Allred, Sid Brevard, Richard T. Davis, Edmund H. Frank

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Study Design. 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). Summary of Background Data. 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). Conclusion. 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.

Original languageEnglish (US)
Pages (from-to)2400-2405
Number of pages6
JournalSpine
Volume34
Issue number22
DOIs
StatePublished - Oct 15 2009
Externally publishedYes

Fingerprint

Military Personnel
Spine
Equipment and Supplies
International Cooperation
Orthopedics
Afghan Campaign 2001-
Organizations
Afghanistan
Compression Fractures
Military Hospitals
Explosions
Wounds and Injuries
Incidence

Keywords

  • Chance fracture
  • improvised explosive device
  • military
  • thoracolumbar flexion-distraction fracture

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Fractures of the thoracolumbar spine sustained by soldiers in vehicles attacked by improvised explosive devices. / Ragel, Brian T.; Allred, C. Dain; Brevard, Sid; Davis, Richard T.; Frank, Edmund H.

In: Spine, Vol. 34, No. 22, 15.10.2009, p. 2400-2405.

Research output: Contribution to journalArticle

Ragel, Brian T. ; Allred, C. Dain ; Brevard, Sid ; Davis, Richard T. ; Frank, Edmund H. / Fractures of the thoracolumbar spine sustained by soldiers in vehicles attacked by improvised explosive devices. In: Spine. 2009 ; Vol. 34, No. 22. pp. 2400-2405.
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abstract = "Study Design. 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). Summary of Background Data. 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). Conclusion. 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.",
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N2 - Study Design. 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). Summary of Background Data. 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). Conclusion. 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.

AB - Study Design. 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). Summary of Background Data. 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). Conclusion. 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.

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