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Causes of simulated transverse process fractures include: Overlying bowel gas Crossing shadow of psoas muscle Ptotic transverse process Persistent apophysis/failure of union Separate ossification centre Lumbar rib Am I highly cynical or what? Adrian Fogarty > from: Robert Spykerman <[log in to unmask]> > date: Tue, 16 Apr 2002 14:54:28 > to: [log in to unmask] > subject: Re: Lumbar transverse process fractures > > That's kind of what I was figuring anyway. I shall give you the full scenario - 30 odd year old lady attending the dept. ONE DAY after alleged injury. Described as being in the passenger seat, seatbelt on, car stationary. Tailgated from behind... > > o/e - guess where we are tender? Heh... > > X ray - couldn't believe it myself. My colleague who saw her earlier actually had also xray'ed her thoracic spine (which also included the L1 transverse process). So... two views.... I know, bowel can make things look iffy, but to me, this transverse process was most definitely clinically and radiologically gone. > > Patient is young, and was not blittered with booze at the time, I figure her history is accurate... DENIES any direct trauma. Ribs okay. > > I am postulating it was somehow her psoas that caused an avulsion type fracture.... > > My convenient "McRae's" seems to say avulsion fractures can occur but by no means is it a big reference orthopaedic tome. I will be doing some digging as well.... Anyone else seen anything like this before? > > Robert Spykerman > ----- Original Message ----- > From: Adrian Fogarty > To: [log in to unmask] > Sent: Tuesday, April 16, 2002 12:40 PM > Subject: Re: Lumbar transverse process fractures > > > I've seen many from direct trauma, but have never seen this fracture from indirect trauma. There is frequently composite shadowing in these AP radiographs however, from overlying bowel shadow etc, that simulates a fracture, and there may also be other variants that simulate fractures (I will check in "Keats" later on today). I very much doubt that the injury mechanism you describe could actually cause such a fracture. > > Adrian Fogarty