Clinical analysis of transverse process fractures: A comprehensive study on patient characteristics, management, and outcomes in trauma care.

BACKGROUND: Transverse process fractures (TPFs) are commonly encountered in trauma patients and are often associated with polytrauma. While traditionally considered stable injuries, recent research suggests their significance in spinal trauma may be under-estimated. This study aims to provide insights into the management and outcomes of TPFs, evaluating their predictive potential for identifying clinically significant spinal fractures and associated injuries. METHODS: A retrospective review of trauma registry data from a Level I trauma center was conducted, encompassing patients with TPFs from September 2022 to September 2023. Inclusion criteria involved patients aged 18 or older with confirmed TPFs via com-puted tomography (CT) and magnetic resonance imaging (MRI), managed nonoperatively. Data on demographics, injury mechanisms, associated injuries, pain management, and treatment outcomes were analyzed. Pain severity and functionality were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). RESULTS: A total of 190 patients, predominantly male (129 patients, 67.9%), with a mean age of 45.7 years, were included in the study. Motor vehicle accidents (MVA) were the leading cause of admission (44.7%). Thoracic injuries were the most common associ-ated pathology. Of the study cohort, 88 patients (46.3%) presented with single-level TPFs, while 102 patients (53.7%) had multilevel fractures. Analysis revealed distinct differences between these groups, with multilevel TPF patients exhibiting a higher frequency of associated injuries and a notable proportion requiring hospitalization or surgical intervention. Multilevel TPF patients exhibited higher initial pain and disability scores compared to single-level TPF patients. Both groups showed significant reductions in VAS and ODI scores at the 3-month follow-up. CONCLUSION: TPFs, previously considered minor injuries, demonstrate significant pain and functional limitations. They often accompany systemic pathologies, particularly in multilevel fractures, necessitating a multidisciplinary approach to management. The "Protection, Rest, Ice, Compression, Elevation" (PRICE) approach, including Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and muscle relaxants, along with collar or brace support when necessary, proves effective in pain management and functional improvement. These findings emphasize the importance of recognizing TPFs as complex injuries requiring tailored management strategies. Further research and collaboration among healthcare providers are warranted to refine treatment approaches and optimize outcomes for patients with TPFs.

Comparison of the Particulate Steroids, Betamethasone and Methylprednisolone, in Caudal Steroid Injection Under Ultrasound Guidance.

BACKGROUND: Pain relief in lumbar disc hernias is a challenging condition. This study retrospectively compared particulate steroids, methylprednisolone acetate (mid-term effective), against betamethasone acetate (long-term effective) on ultrasound-guided caudal epidural injection for lumbar disc herniation. METHODS: A total of 40 patients with L4-5 and/or L5-S1 disc herniation were treated with ultrasound-guided caudal epidural injection between September 2021 and June 2022. Nineteen patients who were given methylprednisolone acetate (group A) as a steroid and a total of 21 patients who were used betamethasone acetate (Group B) were retrospectively collected, and their pain levels and functional improvement were compared retrospectively before, immediately after, and 3 weeks after the injection in terms of the visual analog scale (VAS) and Oswestry Disability Index (ODI) as the efficacy value. RESULTS: There was no statistically significant difference between the groups regarding age, gender, and body mass index (P > 0.05). In group A, preop VAS was 8.84 ± 0.76, immediate postop period 3.10 ± 1.37, and postop third week was 4.73 ± 2.32. In group B, the preop VAS was 8.76 ± 0.76, the postop early period was 3.14 ± 1.27, and the postop third week was 3.12 ± 1.30. In group A preop ODI was 49.84 ± 9.11 and postop third week was 22.84 ± 6.44. In group B, the preop ODI was 46.71 ± 16.15 and postop third week was 30.80 ± 17.65. Significant changes were observed in the reduction of VAS values after the procedure in both groups during the early postoperative period and the third week (P value < 0.05). However, a significant difference was not found between the changes in VAS values between the groups (P value > 0.005). Similarly, significant changes were observed in the decrease of ODI values after the procedure in both groups during the early postoperative period and the third week (P value < 0.05). However, no significant difference was observed in the ODI scores between the two groups. CONCLUSIONS: No significant difference was observed between betamethasone and methylprednisolone. Both steroid groups showed a substantial improvement in the preoperative pain scores of the patients.