Blunt abdominal aortic trauma in association with thoracolumbar spine fractures

All patients with blunt abdominal aortic disruption (BAAD) in the trauma re gistries at the three Regional Trauma Centres were retrospectively reviewed over the last decade. From the 11 465 trauma admissions ISS > 16, 194 sust ained aortic injuries. Eight cases of BAAD were identified, six with concur rent thoracolumbar spine (TLS) fractures (mean ISS 42). Patients with BAAD and TLS were subject to a detailed analysis. Clinically, three injury types were seen, hemodynamically unstable (uncontained full thickness laceration ), stable symptomatic (intimal dissection with occlusion). and stable asymp tomatic (contained full thickness laceration or intimal dissection without occlusion). All spinal column fractures involved a distractive mechanism, o ne with both distractive and translational fracture components. We propose that a distractive force, applied to the aorta lying anterior to the anteri or longitudinal ligament, results in an aortic injury spectrum ranging from an intimal tear to a full thickness laceration, as a related injury. Compu ted tomography (CT) was an important imaging modality in the stable asympto matic patients. All intimal dissections without occlusion were managed non- operatively. With distractive TLS fractures, BAAD needs to be considered. ( C) 2001 Elsevier Science Ltd. All rights reserved.