Early detection of thoracic spine fracture in the multiple trauma patient: Role of the initial portable chest radiograph

Early detection of thoracic spine fracture in the often unconscious multiple trauma patient is of utmost importance. Failure to recognize thoracic spine fracture early could result in neurologic injury during certain radiologic and therapeutic procedures that may be indicated for other injuries. In most trauma centers, the initial evaluation of the multiple trauma patient includes a portable chest radiograph, which may show signs of thoracic injury.To determine the value of the initial portable chest radiograph in the detection of thoracic spine fracture, 34 cases of multiple trauma patients with proven thoracic spine fractures were studied. The initial portable chest radiograph was reviewed for signs of thoracic fracture and compared with the findings on plain bone radiographs and computed tomographic scans and with the patient's medical record.Of the 34 cases, radiologic signs of fracture were initially reported in 18 patients (53%). On re-review, positive signs of fracture were seen in 27 patients (79%). The authors conclude that the initial portable chest radiograph in the multiple trauma patient must be carefully studied for subtle signs of thoracic spine fracture. The most frequent chest radiographic findings were paraspinal hematoma, decreased vertebral body height, and lateral translation of vertebral bodies. Apical pleural cap, increased interpediculate distance, increased interspinous distance (empty vertebral body sign), and rib disarticulation were also noted.