Biomechanics of Thoracolumbar Burst and Chance-Type Fractures during Fall from Height

Study Design In vitro biomechanical study. Objective To investigate the biomechanics of thoracolumbar burst and Chance-type fractures during fall from height. Methods Our model consisted of a three-vertebra human thoracolumbar specimen (n = 4) stabilized with muscle force replication and mounted within an impact dummy. Each specimen was subjected to a single fall from an average height of 2.1 m with average velocity at impact of 6.4 m/s. Biomechanical responses were determined using impact load data combined with high-speed movie analyses. Injuries to the middle vertebra of each spinal segment were evaluated using imaging and dissection. Results Average peak compressive forces occurred within 10 milliseconds of impact and reached 40.3 kN at the ground, 7.1 kN at the lower vertebra, and 3.6 kN at the upper vertebra. Subsequently, average peak flexion (55.0 degrees) and tensile forces (0.7 kN upper vertebra, 0.3 kN lower vertebra) occurred between 43.0 and 60.0 milliseconds. The middle vertebra of all specimens sustained pedicle and endplate fractures with comminution, bursting, and reduced height of its vertebral body. Chance-type fractures were observed consisting of a horizontal split fracture through the laminae and pedicles extending anteriorly through the vertebral body. Conclusions We hypothesize that the compression fractures of the pedicles and vertebral body together with burst fracture occurred at the time of peak spinal compression, 10 milliseconds. Subsequently, the onset of Chance-type fracture occurred at 20 milliseconds through the already fractured and weakened pedicles and vertebral body due to flexion-distraction and a forward shifting spinal axis of rotation.