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.
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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