Crush Fractures

Definition

 

Minimal trauma fracture

- secondary to osteoporosis

- wedge fractures

 

Epidemiology

 

F > M

More common in elderly patients

 

Uncommon in men < 75

- look for alternative diagnosis

 

DDx

 

Renal failure

Malignancy - metastasis

Infection

 

Clinically

 

Can present with pain

Can be asymptomatic

 

Issues

 

1.  Pain

 

2.  Deformity / kyphosis

 

Management

 

Non operative Management

 

Algorithm

 

1.  Exclude other diagnosis

- metastasis

- primary malignancy

- infection

- CRF

 

2.  Pain relief

- analgesics as required

 

3.  Manage osteoporosis

- DEXA scan

- bisphosphonates

- vitamin D + calcium

 

4.  Bracing

- indicated if kyphotic deformity > 20o

 

5.  Early mobilisation

 

Operative Management

 

Options

 

Vertebroplasty

Kyphoplasty

Fusion

 

Vertebroplasty

 

Indications

 

Pain

- non responsive to non operative treatment

 

Technique

 

Percutaneous

- trochar into pedicle under fluoroscopy

- injection PMMA

 

KyphoplastyKyphoplasty Lateral

 

Results

 

Klazen et al Lancet 2010

- RCT of vertebroplasty v non operative treatment

- 431 patients over 50, all T5 or lower

- no complications

- immediate pain relief which was maintained at 1 year follow up

 

Kyphoplasty

 

Indication

- pain relief

- restoration of deformity

 

Technique

 

Kyphoplasty InsertionKyphoplasty Insertion LateralKyphoplasty Balloons APKyphoplasty Balloons Lateral

 

Insert a balloon first and inflate

- bilaterally into each pedicle

- will restore some anatomy

- then inject PMMA

 

Kyphoplasty cement APKyphoplasty cement Lateral

 

Results

 

Liu et al Osteoporosis Int 2010

- RCT of vertebroplasty v kyphoplasty

- improved vertebral height with increased injected PMMA in kyphoplasty

- no difference in outcome regards to pain relief

- 2/50 adjacent segment fractures in kyphoplasty group

- recommended vertebroplasty

 

Fusion

 

Crush Fracture CompressionCrush Fracture Fusion 2