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This is the most common vertebral injury. They occur at the thoracolumbar junction where the thoracic kyphosis ends and the lumbar lordosis starts; they result from a vertical force just in front of the midline of the spine which compresses the anterior lip of the affected vertebra. The posterior ligaments remain intact.
It is most common in elderly patients with porotic bone who slip and land on their bottom. In younger patients, it is associated with falling from a height and landing on their heels (which may also cause a crush fracture of the calcaneum).
The fracture is usually a stable one despite marked pain. The best treatment is activity. Once the pain has subsided - usually after one to two weeks in bed - exercises are encouraged. A corset may help with confidence and lend additional support.
If loss of vertebral height is considerable (greater than 50%) progressive collapse is a risk. A plaster jacket is worn for six to twelve weeks. Spinal fusion may be necessary if severe kyphosis is inevitable.
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