McAfee classification of thoracolumbar spinal fractures

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~~The~~McAfee classification of acute traumatic spinal injuries ~~by McAfee and co workers~~¹ is based on the three column concept of the spine. CT is mandatory for accurate assessment.

Wedged

Classification

Six types of fractures are described:

wedged compression fracture~~Isolated~~
- isolated failure of the anterior column. Wedge-shaped vertebral body. ~~Mechanism~~
- mechanism of injury: forward flexion.~~Stable~~
stable burst fracture~~Anterior~~
- anterior and middle columns fail. No loss of integrity of the posterior elements~~. Mechanism~~
- mechanism of injury: compressive load.~~Unstable~~
unstable burst fracture~~Anterior~~
- anterior and middle columns fail in combination with disruption of the posterior column. ~~The~~
- the posterior column may fail in compression, lateral flexion, or rotation, but not in distraction~~. Tendency~~
- tendency for post-traumatic kyphosis and progressive neural symptoms.~~The~~
- the importance of differentiating compression from burst fractures lies in the higher frequency of neurological deficits associated with the latter.~~Chance~~
chance fracture~~Horizontal~~
- horizontal avulsion injury of the vertebral body. ~~Mechanism~~
- mechanism of injury: flexion about an axis anterior to the anterior longitudinal ligament~~. The~~
- the entire vertebral segment is pulled apart by strong tensile forces.~~Flexion~~
flexion-distraction injury~~Compressive~~
- compressive failure of the anterior column while the middle and posterior columns fail in tension~~. Mechanism~~
- mechanism of injury: flexion about an axis posterior to the anterior longitudinal ligament~~. Tensile~~
- tensile failure of the middle column results in a tear or attenuation of the posterior longitudinal ligament. If the zygoapophyseal joint capsules are disrupted there may be subluxation or dislocation of the facet joints, or fracture of the facets can occur. Most varieties of this injury are potentially unstable because the ligamentum flavum, interspinous ligament, and supraspinous ligament usually are torn.~~Translational~~
translational injury~~All~~
- all three columns have failed in shear~~. Displacement~~
- displacement in the transverse plane with alignment disruption of the spinal canal. ~~Includes~~
- includes Holdsworth's slice fractures, rotational fracture-dislocations and pure dislocations.

-<p>The classification of acute traumatic spinal injuries by McAfee and co workers<sup>1</sup> is based on the <a href="/articles/three-column-concept-of-thoracolumbar-spinal-fractures">three column concept of the spine</a>. CT is mandatory for accurate assessment.</p><h5>Wedged compression fracture</h5><p>Isolated failure of the anterior column. Wedge-shaped vertebral body. Mechanism of injury: forward flexion.</p><h5>Stable burst fracture</h5><p>Anterior and middle columns fail. No loss of integrity of the posterior elements. Mechanism of injury: compressive load.</p><h5>Unstable burst fracture</h5><p>Anterior and middle columns fail in combination with disruption of the posterior column. The posterior column may fail in compression, lateral flexion, or rotation, but not in distraction. Tendency for post-traumatic kyphosis and progressive neural symptoms.</p><p>The importance of differentiating compression from burst fractures lies in the higher frequency of neurological deficits associated with the latter.</p><h5>Chance fracture</h5><p>Horizontal avulsion injury of the vertebral body. Mechanism of injury: flexion about an axis anterior to the anterior longitudinal ligament. The entire vertebral segment is pulled apart by strong tensile forces.</p><h5>Flexion-distraction injury</h5><p>Compressive failure of the anterior column while the middle and posterior columns fail in tension. Mechanism of injury: flexion about an axis posterior to the anterior longitudinal ligament. Tensile failure of the middle column results in a tear or attenuation of the posterior longitudinal ligament. If the zygoapophyseal joint capsules are disrupted there may be subluxation or dislocation of the facet joints, or fracture of the facets can occur. Most varieties of this injury are potentially unstable because the ligamentum flavum, interspinous ligament, and supraspinous ligament usually are torn.</p><h5>Translational injury</h5><p>All three columns have failed in shear. Displacement in the transverse plane with alignment disruption of the spinal canal. Includes <a href="/articles/holdsworth-s-slice-fractures">Holdsworth's slice fractures</a>, rotational fracture-dislocations and pure dislocations.</p>
+<p><strong>McAfee classification</strong> of acute traumatic spinal injuries is based on the <a href="/articles/three-column-concept-of-thoracolumbar-spinal-fractures">three column concept of the spine</a>. CT is mandatory for accurate assessment.</p><h4>Classification</h4><p>Six types of fractures are described:</p><ul>
+<li>
+<strong>wedged compression fracture</strong><ul>
+<li>isolated failure of the anterior column. Wedge-shaped vertebral body.</li>
+<li>mechanism of injury: forward flexion</li>
+</ul>
+</li>
+<li>
+<strong>stable burst fracture</strong><ul>
+<li>anterior and middle columns fail. No loss of integrity of the posterior elements</li>
+<li>mechanism of injury: compressive load</li>
+</ul>
+</li>
+<li>
+<strong>unstable burst fracture</strong><ul>
+<li>anterior and middle columns fail in combination with disruption of the posterior column.</li>
+<li>the posterior column may fail in compression, lateral flexion, or rotation, but not in distraction </li>
+<li>tendency for post-traumatic kyphosis and progressive neural symptoms</li>
+<li>the importance of differentiating compression from burst fractures lies in the higher frequency of neurological deficits associated with the latter</li>
+</ul>
+</li>
+<li>
+<strong>chance fracture</strong><ul>
+<li>horizontal avulsion injury of the vertebral body.</li>
+<li>mechanism of injury: flexion about an axis anterior to the anterior longitudinal ligament </li>
+<li>the entire vertebral segment is pulled apart by strong tensile forces</li>
+</ul>
+</li>
+<li>
+<strong>flexion-distraction injury</strong><ul>
+<li>compressive failure of the anterior column while the middle and posterior columns fail in tension</li>
+<li>mechanism of injury: flexion about an axis posterior to the anterior longitudinal ligament</li>
+<li>tensile failure of the middle column results in a tear or attenuation of the posterior longitudinal ligament. If the zygoapophyseal joint capsules are disrupted there may be subluxation or dislocation of the facet joints, or fracture of the facets can occur. Most varieties of this injury are potentially unstable because the ligamentum flavum, interspinous ligament, and supraspinous ligament usually are torn</li>
+</ul>
+</li>
+<li>
+<strong>translational injury</strong><ul>
+<li>all three columns have failed in shear</li>
+<li>displacement in the transverse plane with alignment disruption of the spinal canal.</li>
+<li>includes <a href="/articles/holdsworth-s-slice-fractures">Holdsworth's slice fractures</a>, rotational fracture-dislocations and pure dislocations</li>
+</ul>
+</li>
+</ul>

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