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Hammack: What Is A Burst Fracture?

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Now that the racing world has been enlightened regarding Tony Stewart’s back injury from a semi-secret sand buggy accident on Sunday, many people are probably scratching their heads and asking themselves just what is a burst fracture?

More importantly, what is Tony’s specific prognosis?  How long will he be out of the race car? At the moment, it looks as though his quest toward a Daytona 500 ring may not be the only thing that has “burst” in the past few days.

A burst fracture is a descriptive term for an injury to the spine in which the vertebral body is severely compressed. They typically occur from severe trauma, such as a motor vehicle accident or a fall from a height. With a great deal of force vertically onto the spine, a vertebra may even be crushed.

If it is only crushed in the front part of the spine, it becomes wedge-shaped and is called a compression fracture. However, if the vertebral body is crushed in all directions, it is called a burst fracture.

The term “burst” implies that the margins of the vertebral body are spread out in all directions. This is a much more severe injury than a compression fracture for two reasons. With the bony fragments spreading in all directions, the spinal cord is liable to be injured. The bony fragment that is spread out toward the spinal cord can bruise the cord causing paralysis or partial neurological injury.  Additionally, by crushing the entire margin of the vertebral body, the spine is much less stable than a compression fracture.

Neurological injuries from a burst fracture range from none at all to complete paralysis. The degree of neurological injury is usually due to the amount of force that is present at the time of the injury and the amount of compromise of the spinal canal.

With a greater amount of force, more bony fragments can be forced into the spinal canal causing greater loss of spinal cord function. This may cause loss of strength, sensation or reflexes below the level of the injury.

Typically, in a burst fracture that occurs at the junction of the thoracic and lumbar spines paralysis of the legs and loss of control of the bowel and bladder may result. In an incomplete spinal cord injury only partial paralysis or reflex loss is seen. With mild burst fractures only transient symptoms may be present or no neurological injury may be present.

Simply stating, burst fractures cause severe pain. Typically, this is pain at the level of the fracture located in the back. However, pain may also be present in the legs following the distribution of the affected nerves. Many patients complain of an electric shock type sensation into their legs when there is spinal cord compression. Most patients with a burst fracture are unable to walk immediately after the injury. Seldom, the patient may walk away from an accident and still have a burst fracture. However, often the amount of pain that is present is severe enough that patients know it is a good idea not to walk.

The diagnosis of a burst fracture is usually made by x-rays and a CAT scan. Occasionally, an MRI scan may be ordered as well, in order to assess the amount of soft tissue trauma, bleeding or ligament disruption. The review of the CAT scan and x-rays allow the treating physician to make a determination as to the level of the fracture. Whether it is a compression fracture, burst fracture or fracture dislocation and to determine the amount of spinal canal compromise and spinal angulation. All of these factors enter into the treatment decision process.

The physical exam should be performed to document both spinal deformity, that is, angulation of the spine or tenderness of the spine at the level of fracture, as well as a neurological exam.

A neurological exam should include testing of the muscle strength, sensation and reflexes of the lower extremities, as well as testing of bowel and bladder sphincter control.

Now that we kind of understand just what the injury is that Smoke suffered last Sunday the next question asked is what is the recovery time for this back injury?

According to some orthopedic surgeons that are familiar with this kind of injury their opinion is that it will take at least 2-3 months for this injury to heal.  Of course we all know that those figures are very general.  Could Smoke be back into a race car in less than 2-3 months? And he will be wearing a very cumbersome lumbar back brace?

Of course that could be possible, however let me remind you that Tony is 44 years old, and his last major injury – the compound fracture of his right leg in August of 2013 – healed extremely slow, impacting his on-track performance.

Could this severe injury be the straw that broke the camel’s back, literally and figuratively for Smoke?  Understand that this injury could easily have left Stewart paralyzed.  This burst fracture is the kind of injury that impacts your ability to walk and to move for the rest of your life.  That is something vitally important to take into consideration when talking about returning to the race car. You can not take the unnecessary chance of hitting anything at all!

As of this very minute the answer to the above question is not available, and will be one of the hot topics for conjecture for the next few days and weeks.  There is absolutely no doubt that Stewart and his injury will be the hot-button topic of conversation for all of the media as the Sprint Cup haulers roll through the tunnel at Daytona in about six days.

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About Leon Hammack

Leon Hammack is a retired airline pilot and avid race fan. Leon is a contributing writer and photographer for all three of NASCAR's touring series, as well as sprint car and midget racing. A native of Fresno, CA now wintering in Yuma, AZ., additionally, he spends the summer months near Coos Bay, OR. You may contact Leon on Twitter @captainblowdri

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