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 -----
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