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Classification of Thoracolumbar Fractures

Minor injuries
- Fracture of transverse process
- Fracture of articular process
- Isolated fractures of the spinous process
 Burst Fracture of L2
Major injuries
- Holdsworth Classification
- Denis Classification
- McAfee Classification
- Comprehensive Classification - Magerl

I) Holdsworth Classification-
Holdsworth F: Fractures, dislocations and fracture-dislocations of the spine. J Bone Joint Surg (Am) 1970; 53A: 1534-1559

- 2-Column Model : Anterior and Posterior Columns
- based on degree of injury to the posterior ligamentous complex
Stable fractures - 1) Wedge compression fracture
2) Burst compression fracture
Unstable fractures - 3) Dislocations
4) Extension fractures and dislocations
5) Rotational fracture-dislocation

II) Denis Classification-
Denis F: Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop 1984; 189:65-76

- 3-Column Model
- based on integrity of the middle column
  Anterior Column Middle Column Posterior Column
Compression fracture    X - injured    
Burst fracture    X - injured    X - injured  
Seat-belt type fracture      X - injured    X - injured
Fracture dislocation    X - injured    X - injured    X - injured

III) McAfee Classification
McAfee PC, Yuan HA, Fredrickson BE, Lubicky JP: The value of computed tomography in thoracolumbar fractures. J Bone Joint Surg (Am) 1983; 64A: 461-473

- 3-Column Model
- based on mechanism of injury
Wedge-compression fracture - flexion, AC
Stable burst fracture - compression, AC, MC
Unstable burst fracture - compression, AC, MC, PC- compression, lateral flexion, rotation
Chance fracture - flexion (axis anterior to AC) AC, MC, PC
Flexion-distraction injury - compression, AC, flexion, MC, PC
Translational injuries - transverse displacement, AC, MC, PC

IV) Comprehensive Classification-
Magerl Magerl F, Aebi M: A Comprehensive Classification of Thoracic and Lumbar Injuries. AO ASIF Principles in Spine Surgery, 1998, 20-41

- 2-Column Model
- based on 3 mechanisms of injury: compressive force, tensile force and axial torque
Type A - Vertebral body compression
  - A1 Impaction fractures
- A2 Split fractures
- A3 Burst fractures
Type B - Anterior and posterior element injury with distraction
  - B1 Posterior disruption predominantly ligamentous
- B2 Posterior disruption predominantly osseous
- B3 Anterior disruption through the disc
Type C - Anterior and posterior element injury with rotation
  - C1 Type A injuries with rotation
- C2 Type B injuries with rotation
- C3 Rotational-shear injuries
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