Vertebral burst fractures: CT analysis of the retropulsed fragment.

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Abstract
Ten cases of retropulsed thoracolumbar vertebral body fragments that had been documented by CT [computed tomography] were reviewed to define and characterize the nature, appearance, and position of the retropulsed fragment. All of the retropulsed fragments arose from the superior aspect of the veretebral body. Five of 10 patients had a vertical fracture within the retropulsed fragment. Three of 10 fragments had anteriorly rotated 90.degree. .+-. 60.degree., so that the cartilaginous and end plate faced anteriorly; also, they had migrated 3-8 mm in a craniad or caudad direction. Six of 10 patients had an associated vertical or Y-shaped fracture originating from the region of the basivertebral foramen and passing into the inferior one-half of the vertebral body. The presence of a retropulsed fragment is nearly pathognomonic of an axial compression injury. Characteristics of this lesion that may hinder surgical reduction are the intra-fragment fracture, rotation and craniocaudad movement are given.