SET T0020 -
Emergency Department

Fractures of the transverse processes of L3 and L4 vertebrae on the left side.

These fractures are occasionally sustained following a fall - often when there has been a twisting component - and are frequently overlooked.

Potential Pitfall: normal gas shadows in the bowel frequently cross the transverse processes and a streak of gas can give the impression of a fracture line.

Observations:

• Crush fracture of the body of L2 vertebra.
• A large fragment is seen to intrude into the spinal canal.
• Ergo, two of the three columns are invoved by the injury - this indicates an unstable injury. 

(The subsequent CT confirms the involvement of the two columns. This was the major finding that was evident on the plain radiograph of the lumbar spine).

The Three Column Principle and instability . . .

See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Pages 200 and 209

Transverse process fractures on the right side: affecting the L2, L3, and L4 vertebrae.

Crush fracture of the body of T10 vertebra.