An 85-year-old woman is brought to your facility after being injured during a tornado that touched down in your town. She was in her bedroom when the storm hit, causing her roof to collapse and debris to strike her on the back. She denies any head injury or loss of consciousness. Her only complaint is mid-back pain.
Medical history is significant for controlled hypertension and dyslipidemia. On physical examination, she has mild to moderate generalized tenderness in her mid back. There is no obvious crepitus or ecchymosis. The patient is otherwise neurovascularly intact, and the remainder of her exam is normal.
What does this lateral view of the thoracic spine reveal?
ANSWER
The radiograph demonstrates a moderate wedge compression fracture of the T9 vertebra; approximate compression is 50% to 60%. In addition, the T8 vertebra has some evidence of compression (about 20% to 30%).
While both fractures could be old, hospital admission for pain control and further work-up is warranted because of the mechanism of injury and the fact that the patient is currently symptomatic. Typically, MRI will differentiate new versus old fractures, whereas CT is not always as sensitive for making this determination.
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