Transverse Process Fractures of the Thoracic Vertebrae-the Significance of This Injury in the Context of Medicolegal Opinions on High-energy Trauma Cases

Overview

Journal Int J Legal Med

Specialty Forensic Sciences

Date 2019 Sep 19

PMID 31529273

Authors

Aleksandra Borowska-Solonynko

Victoria Prokopowicz

Affiliations

Soon will be listed here.

Abstract

Thoracic transverse process fractures (TTPFs) are injuries that go unnoticed during traditional autopsies, as demonstrated by a lack of medicolegal publications regarding TTPFs. However, postmortem computed tomography (PMCT) has made detection of this type of injury easy. Thus, the goal of our study was to analyze the significance of TTPFs in the context of medicolegal opinions. Forensic autopsy reports and PMCT scans of 116 people who had died from high-energy trauma were analyzed. TTPFs were found in 34.48% (n = 40) of the total test group. The highest proportions of TTPFs were found in drivers (50%, n = 8) and in victims of falls from heights (41%, n = 14). Among seven car passengers, only one victim had suffered TTPFs. In comparison with persons without TTPFs, persons with TTPFs demonstrated more severe general injuries, especially to the chest and abdomen, and more often (in 90% of cases) died at the scene of injury (all these differences were statistically significant; p < 0.0001). Pedestrian TTPFs were present only in victims struck from their front or back. TTPFs in victims of falls were found only in those cases in which the height of the fall was at least 9 m. The presence of TTPFs indicates that the application of a very strong force leads to injuries that, in most cases, result in death at the scene of the event. Detecting TTPFs provides additional information about the mechanism of trauma, especially in pedestrians, drivers, passengers, and victims of falls from heights.

References

Jalalzadeh H, Giannakopoulos G, Berger F, Fronczek J, van de Goot F, Reijnders U . Post-mortem imaging compared with autopsy in trauma victims--A systematic review. Forensic Sci Int. 2015; 257:29-48. DOI: 10.1016/j.forsciint.2015.07.026. View

Sturm J, PERRY Jr J . Injuries associated with fractures of the transverse processes of the thoracic and lumbar vertebrae. J Trauma. 1984; 24(7):597-9. DOI: 10.1097/00005373-198407000-00008. View

Goodear M, Styles C . Stress fractures of the thoracic spine transverse processes in a water skier. Clin Nucl Med. 1999; 24(4):285-6. DOI: 10.1097/00003072-199904000-00021. View

Gultekin G, Gulmen V, Ars E, Dilbaz S, Zileli M . Transverse Process Fractures: A Clinical Series and Coronal Injury of the Spine. World Neurosurg. 2018; . DOI: 10.1016/j.wneu.2018.11.147. View

Graziani G, Tal S, Adelman A, Kugel C, Bdolah-Abram T, Krispin A . Usefulness of unenhanced post mortem computed tomography - Findings in postmortem non-contrast computed tomography of the head, neck and spine compared to traditional medicolegal autopsy. J Forensic Leg Med. 2018; 55:105-111. DOI: 10.1016/j.jflm.2018.02.022. View

Barker P, Freeman A, Urquhart D, Anderson C, Briggs C . The middle layer of lumbar fascia can transmit tensile forces capable of fracturing the lumbar transverse processes: an experimental study. Clin Biomech (Bristol). 2010; 25(6):505-9. DOI: 10.1016/j.clinbiomech.2010.02.008. View

Huelke D, MacKay G, Morris A . Vertebral column injuries and lap-shoulder belts. J Trauma. 1995; 38(4):547-56. DOI: 10.1097/00005373-199504000-00014. View

Kasahara S, Makino Y, Hayakawa M, Yajima D, Ito H, Iwase H . Diagnosable and non-diagnosable causes of death by postmortem computed tomography: a review of 339 forensic cases. Leg Med (Tokyo). 2012; 14(5):239-45. DOI: 10.1016/j.legalmed.2012.03.007. View

Leth P, Ibsen M . Abbreviated injury scale scoring in traffic fatalities: comparison of computerized tomography and autopsy. J Trauma. 2009; 68(6):1413-6. DOI: 10.1097/TA.0b013e3181b251b8. View

10.

Newell N, Pearce A, Spurrier E, Gibb I, Webster C, Clasper J . Analysis of isolated transverse process fractures sustained during blast-related events. J Trauma Acute Care Surg. 2018; 85(1S Suppl 2):S129-S133. DOI: 10.1097/TA.0000000000001815. View

11.

Lombardo G, Petrone P, Prabhakaran K, Marini C . Isolated transverse process fractures: insignificant injury or marker of complex injury pattern?. Eur J Trauma Emerg Surg. 2016; 43(5):657-661. DOI: 10.1007/s00068-016-0745-7. View

12.

Sochor M, Trowbridge M, Boscak A, Maino J, Maio R . Postmortem computed tomography as an adjunct to autopsy for analyzing fatal motor vehicle crash injuries: results of a pilot study. J Trauma. 2008; 65(3):659-65. DOI: 10.1097/TA.0b013e3181238d66. View

13.

Nagasawa D, Bui T, Lagman C, Lee S, Chung L, Niu T . Isolated Transverse Process Fractures: A Systematic Analysis. World Neurosurg. 2017; 100:336-341. DOI: 10.1016/j.wneu.2017.01.032. View

14.

Hauser C, Visvikis G, Hinrichs C, Eber C, Cho K, Lavery R . Prospective validation of computed tomographic screening of the thoracolumbar spine in trauma. J Trauma. 2003; 55(2):228-34; discussion 234-5. DOI: 10.1097/01.TA.0000076622.19246.CF. View

15.

Homnick A, Lavery R, Nicastro O, Livingston D, Hauser C . Isolated thoracolumbar transverse process fractures: call physical therapy, not spine. J Trauma. 2008; 63(6):1292-5. DOI: 10.1097/TA.0b013e31812eed3c. View

16.

Puderbaugh M . A Report of Transverse Process Fractures Secondary to the Centrifuge in a Healthy Aviator. Aerosp Med Hum Perform. 2016; 87(7):655-8. DOI: 10.3357/AMHP.4541.2016. View

17.

Barker P, Urquhart D, Story I, Fahrer M, Briggs C . The middle layer of lumbar fascia and attachments to lumbar transverse processes: implications for segmental control and fracture. Eur Spine J. 2007; 16(12):2232-7. PMC: 2140134. DOI: 10.1007/s00586-007-0502-z. View

18.

Bui T, Nagasawa D, Lagman C, Chen C, Chung L, Voth B . Isolated Transverse Process Fractures and Markers of Associated Injuries: The Experience at University of California, Los Angeles. World Neurosurg. 2017; 104:82-88. DOI: 10.1016/j.wneu.2017.04.137. View

19.

Willard F, Vleeming A, Schuenke M, Danneels L, Schleip R . The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat. 2012; 221(6):507-36. PMC: 3512278. DOI: 10.1111/j.1469-7580.2012.01511.x. View

20.

Moskala A, Wozniak K, Kluza P, Romaszko K, Lopatin O . Usefulness of post mortem computed tomography versus conventional forensic autopsy of road accident victims (drivers and passengers). Arch Med Sadowej Kryminol. 2018; 67(2):91-103. DOI: 10.5114/amsik.2017.71451. View