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Flexion Fracture: Causes, Symptoms and Treatment

A flexion fracture is a bone break caused by excessive bending force. It commonly affects the spine and frequently occurs as a result of accidents or falls.

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Things worth knowing about "Flexion Fracture"

A flexion fracture is a bone break caused by excessive bending force. It commonly affects the spine and frequently occurs as a result of accidents or falls.

What Is a Flexion Fracture?

A flexion fracture is a type of bone fracture caused by an excessive bending (flexion) force applied to a bone or vertebra. When the bending load exceeds the structural capacity of the bone, it breaks. The spine is the most commonly affected region, particularly the thoracic and lumbar segments. The term derives from the Latin words flexio (bending) and fractura (break).

Causes

Flexion fractures occur when forces bend a bone beyond its natural range of tolerance. Common causes include:

Motor vehicle accidents: Sudden deceleration or impact, particularly with a seatbelt in place (known as a seatbelt fracture)
Falls from height: Landing on the feet or buttocks, transmitting force up through the spine
Sports injuries: Especially in skiing, cycling, or contact sports
Osteoporosis: Weakened bones may fracture under minimal bending load
Direct trauma: A blow or fall that applies a strong bending force to a bone

Types of Flexion Fractures

Wedge Fracture (Compression Fracture)

The most common type: the front edge of a vertebral body is compressed, resulting in a wedge-shaped deformity. This form occurs most often in older adults with osteoporosis.

Seatbelt Fracture (Chance Fracture)

This variant typically occurs in road traffic accidents where a seatbelt is worn. The abdomen acts as a pivot point, causing the posterior spine to be placed under tension while the anterior spine is compressed.

Flexion-Distraction Fracture

This type involves both bending and tensile forces acting simultaneously on the spine, causing the affected structures to be pulled apart. This can lead to significant spinal instability.

Symptoms

Symptoms depend on the bone involved and the severity of the fracture. Common signs include:

Severe, localized pain at the fracture site
Swelling and tenderness on pressure
Restricted range of motion
Back pain and muscle spasms in spinal fractures
In severe cases: numbness, tingling, or paralysis due to nerve compression

Diagnosis

Several imaging methods are used to diagnose a flexion fracture:

X-ray: The initial imaging study used to detect fractures and misalignments
Computed tomography (CT): Provides detailed cross-sectional images, revealing even small fractures and fragment displacement
Magnetic resonance imaging (MRI): Particularly useful for assessing soft tissues, ligaments, intervertebral discs, and neural structures

Fracture classification systems such as the AO Classification or the Denis Classification help determine spinal stability and guide treatment decisions.

Treatment

Conservative Treatment

Stable flexion fractures without neurological deficits are often managed non-surgically:

Immobilization using an orthosis, brace, or cast
Pain management with anti-inflammatory medications
Physiotherapy to strengthen supporting musculature
Controlled rest and gradual mobilization

Surgical Treatment

Unstable fractures, significant fragment displacement, or neurological deficits typically require surgical intervention:

Percutaneous vertebroplasty or kyphoplasty: Minimally invasive procedures to stabilize vertebral bodies using bone cement
Posterior or anterior instrumentation: Insertion of screws, rods, or plates to stabilize the spine
Decompression surgery: Relieving pressure on the spinal cord or nerve roots

Recovery and Prognosis

Healing time depends on the severity of the fracture, the age of the patient, and the chosen treatment. Stable flexion fractures treated conservatively typically heal within 6 to 12 weeks. Unstable fractures or those with neurological complications require longer rehabilitation. Physiotherapy plays a crucial role in restoring mobility and strength.

References

Vaccaro, A. R. et al. - The Thoracolumbar Injury Classification and Severity Score: A New Paradigm for the Treatment of Thoracolumbar Spine Trauma. In: Journal of Orthopaedic Trauma, 2005.
Magerl, F. et al. - A comprehensive classification of thoracic and lumbar injuries. In: European Spine Journal, 1994.
American Academy of Orthopaedic Surgeons (AAOS) - Spinal Fractures: Overview and Treatment Guidelines, available at: www.aaos.org

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