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Fractures of the Thoracolumbar Spine Sustained by Soldiers in Vehicles Attacked by Improvised Explosive Devices

Ragel, Brian T. MD*; Allred, C Dain MD; Brevard, Sid MD, MPH; Davis, Richard T. MD§; Frank, Edmund H. MD

doi: 10.1097/BRS.0b013e3181b7e585
Clinical Case Series

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.

This study reports the types of thoracolumbar fractures sustained by soldiers injured by improvised explosive devices targeted against armored vehicles that were seen at a military hospital in Afghanistan. A higher than expected incidence of flexion-distraction fractures (Chance) were noted for both overall trauma patients and spine fractures of 1.82% and 38%, respectively.

From the *Department of Neurosurgery, David Grant Medical Center, Travis Air Force Base, CA; †Department of Orthopedics, David Grant Medical Center, Travis Air Force Base, CA; ‡Department of Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD; §Department of Orthopedics, Mike O’Callaghan Federal Hospital, Nellis Air Force Base, NV; and ¶Department of Neurosurgery, Oregon Heath Sciences University, Portland, OR.

Acknowledgment date: January 5, 2009. Revision date: March 22, 2009. Acceptance date: April 1, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the United States Air Force, the Department of Defense, or the Department of Veterans Affairs.

Address correspondence and reprint requests to Brian T. Ragel, MD, Department of Neurosurgery, Oregon Health Sciences University, 3303 SW Bond Ave, CH8N, Portland, OR 97239; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.