Original Articles

By Dr. Ahidjo Kawu
Corresponding Author Dr. Ahidjo Kawu
Dept of Orthopaedics, UATH, Gwagwalada Abuja, - Nigeria
Submitting Author Dr. Ahidjo Kawu

Thoracic fractures, Neurologic deficit, Motorcycle accident, Frankel

Kawu A. Thoracic Spine Fractures Following Motorcycle Accidents in Nigeria. WebmedCentral ORTHOPAEDICS 2010;1(10):WMC00872
doi: 10.9754/journal.wmc.2010.00872
Submitted on: 01 Oct 2010 10:01:51 PM GMT
Published on: 01 Oct 2010 11:12:22 PM GMT


Background: Thoracic spine (T1-T12) fracture following motorcycle accident (MCA) is not uncommon injury and the topic has not been reported on in Nigeria.

Objective: The aim of this study is to report on the demographic pattern of presentation and the short term neurologic outcome of conservative treatment of thoracic spine fractures following MCA in Abuja Nigeria.

Methods: Age, sex, fracture pattern, region of fracture, neurologic status at presentation and  outcome of patients treated conservatively for thoracic spine fractures following MCA from 1997 to 2007 were retrospectively studied from case notes.

Results: There were 27 patients (25M, 2F, M/F 12.5: 1) with mean age of 28.2± 10.8 years over the 10-year period. The seventh thoracic spine T7 (22.2%) and the fourth to seventh thoracic spine (T4-T7) were the commonest level and region of injury respectively. Fracture-dislocation was the commonest fracture pattern noted. Fifteen (55.6%) patients had complete neurologic deficit. Seven (25.9%) patients left against medical advice and 5(18.5%) died during the review interval. Frankel’s grading improved in 4 (14.8%) patients at least 2 levels at 6 month of evaluations. The mean duration of hospitalization was 69.5± 20.7 days.

Conclusion: Thoracic spine fracture following MCA is not uncommon and a significant cause of morbidity and mortality. The patients were predominantly young economic active, male adults. The T7 and T4-T7 appears to be the commonest level and region of injury respectively. Fracture-dislocation was the commonest fracture pattern. The short term neurologic outcome was satisfactory in a small minority (14.8%) of the patients.


Thoracic spine fracture1-23 usually occurs in high energy injury. As the motorcycle became an increasingly popular mode of transportation and recreation, a concomitant increase in injuries from motorcycle accidents has been reported.7,21,23 Thoracic fractures following MCA have been well documented in many reports1-11,13-22 but short term neurologic outcome has not been reported on in Nigeria.

With emerging trends in the use of motorcycles as a means of transportation and recreation and the attendant injuries from the motorcycle accidents, there is a need to focus attention on this type of injury so as to understand the outcome and its consequences for a developing country like Nigeria.

This is a retrospective study of patients with thoracic spine fracture following MCA at the University of Abuja Teaching Hospital Gwagwalada, Abuja from July 1999 to July 2009 to define types of fractures, region of fractures and the short term outcome of conservative treatment.


The records of patients admitted at the University of Abuja Teaching Hospital, Gwagwalada from 1st July 1997 to 1st July 2007 were reviewed. All patients with thoracic spine fractures following MCA admitted onto the ward were included in this study. Data extracted were age, sex, type of fracture, region of fracture, neurologic outcome of the treatment offered and duration of hospitalization.

Fracture was diagnosed with plain radiograph using anteroposterior and lateral view and where necessary computed tomogram was done; and classified using the Denis’ classification12.

The conservative treatment involved keeping patients in bed with thoracolumbar brace for 6 weeks and then discharged on the brace for another 3 month irrespective of the neurologic status. The neurologic outcome was determined using Frankel’s grading16. Ethical approval was sought and approval granted for this study.

The results were analysed by means, standard deviation, simple percentages and Chi-square as appropriate using Statistical Package for Social Sciences (SPSS) 17.0;  p-value of <0.05 is significant.


Twenty-seven patients comprising 25(92.6%) male and 2(7.4%) female (M: F= 12.5: 1) were studied (Table 1). Thirty-two thousand, six-hundred and forty-one cases of trauma presented in the casualty was, 5,416 cases were admitted into the wards and 202 cases were spinal column injury. The mean age was 28.2.2± 10.8 years with range of 15 to 66 years.  Twenty-three (85.2%) patients were in the age group 15-44years. Figure 1 shows the level and region of injury in the thoracic spine.

Seven (26.0%) patients had compression fractures, five (18.5%) had burst fractures and 15 (55.5%) had fracture dislocations and there was none with a seat-beat fracture (Table 2). Fifteen (55.5%) patients had complete neurologic deficit (Table 3). Frankel’s grading at presentation and at 6 months is shown in Table 4.  

Fifteen (55.5%) patients were discharged from the ward, 5 (18.5%) died and 7 (26.0%) left hospital against medical advice. The mean duration of hospitalization was 69.5±20.7 (range 1- 197 days).


Thoracic spine fractures occurred in predominantly young, economic active adult males. This is similar to the findings of other workers1-23. The male to female ratio was 12.5: 1 which was higher than the previously reported figures7,18,21 of between 2.6: 1 and 9.8: 1. This high figure may be due to the high number of males who ride motorcycle as a vocation in Nigeria compared to their female counterpart.

The T7 thoracic spine was the most frequently involved with the T4- T7 segment the most commonly affected area of the thoracic spine. This corresponds to the findings in other reports2,5-9,14-15,17-22. Kupferschmid and co worker7 postulated that the accentuation of the kyphotic curvature of the thoracic spine when a rider is catapulted over the handlebars of the motorcycle may be responsible for the predominance of injury at T4-T7 region. When a biker is thrown off the bike, the lordotic curve of the cervical spine is straightened out when flexed as a defence mechanism and this lead to an increase in the kyphosis of the thoracic spine region. Axial force is loaded on impact from the top of the spine or across the shoulder which is then transmitted down the spinal column till the area of maximum curvature is met and this correspond to T4-T7 region.

The commonest pattern was fracture-dislocation (55.5%). The shearing force on the thoracic spine from massive blow to the back with accompanying displacement of the vertebral body fracture of the articular processes and rupture of the ligamentous complex is the cause of fracture-dislocation.24   

Fifteen (55.5%) patients presented with complete neurologic deficit at the time of admission. This figure was lower than that in the series of Kupferschmid and co-worker7and Shrosbree and co-workers19 that reported 62% and 81% respectively. The difference in our study could be due to a large number of patients in our own series and the duration.

Four (14.8%) patients with incomplete neurologic deficit improved at least 2 levels using the Frankel’s score at 6 months. This was higher than that reported by Kupferschmid and co-workers7. This could be the natural course of the injury in these patients.


Thoracic spine fracture following motorcycle accident is not uncommon in Nigeria affecting predominantly young economically active males. The T7 thoracic spine was the most frequently involved with T4- T7 segment the most commonly affected area of the thoracic spine. Fracture-dislocation was the commonest fracture pattern observed. The short term neurologic outcome was satisfactory in a small minority (14.8%) of the patients.


1. Hanley EN, Eskay ML. Thoracic spine fractures. Orthopaedics 1989; 12: 689-96
2. Bohlman HH. Traumatic fractures of the upper thoracic spine with paralysis. J Bone Joint Surg 1974; 56A: 1299
3. Burke DC, Murray DD. The management of thoracic and thoracolumbar injuries of the spine and neurologic involvement. J Bone Joint Surg 1976; 52B: 72-8
4. Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JD, Walsh JJ. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia.  Paraplegia 1969; 7: 179-92
5. Bohlman HH, Freehafer A, Dejak J. The results of treatment of acute injuries of the upper thoracic spine with paralysis. J Bone Joint Surg Am 1985; 67: 360-9
6. Daffner RH, Deeb ZL, Rothfus WE. Thoracic fractures and dislocations in motorcyclists. Skeletal Radiol 1987; 16: 280-4
7. Kupferschmid JP, Weaver ML, Raves JJ, Diamond DL. Thoracic spine injuries in victims of motorcycle accident. J Trauma 1989; 29: 593-6
8. Argenson C, Boileau P, de Peretti F, Lovet J, Dalzotto H. [Fractures of the thoracic spine (T1-T10). Apropos of 105 cases]. Rev Chir Orthop Reparatrice Appar Mot 1989; 75: 370-86. French.
9. el-Khoury GY, Whitten CG. Trauma to the upper thoracic spine: anatomy, biomechanics, and unique imaging features. AJR Am J Roentgenol 1993; 160: 95-102
10. Brouwers MA, Veldhuis EF, Zimmerman KW. Fracture of the thoracic spine with paralysis and esophageal perforation. Eur Spine J 1997; 6: 211-3
11. Daffner RH, Deeb ZL, Goldberg AL, Kandabarow A, Rothfus WE. The radiologic assessment of post-traumatic vertebral stability. Skeletal Radiol 1990; 19: 103-8.
12. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 1983; 8: 817-31
13. Harryman DT. Complete fracture-dislocation of the thoracic spine associated with spontaneous neurologic decompression. A case report. Clin Orthop, 1986; 207: 64-9
14. Roger LF, Thayer C, Weinberg PE, Kim KS. Acute injuries of the upper thoracic spine associated with paraplegia. Am J Roentgenol 1980; 134: 67-72
15. Daffner RH, Deeb ZL, Rothfus WE. “Fingerprints”of vertebra trauma- a unifying concept based on mechanisms. Skeletal Radiol 1986; 15: 51-8
16. Frankel HL, Rozycki GS, Ochsner MG, Harviel JD, Champion HR. Indication for obtaining surveillance thoracic and lumbar radiographs. J Trauma 1994; 37: 673-7
17. Deaner RM, Fitchett UH. Motorcycle trauma. J Trauma 1975; 15: 678-81
18. Haddad JP. Motorcycle accidents: a review of 77 patients treated in three-month period. J Trauma 1976; 16: 550-7
19. Shrosbree RO. Spinal cord injuries as a result of motorcycle accidents. Paraplegia 1979: 16: 102-12
20. Speca JM, Cowell HR. Minibike and motorcycle accidents in adolescents: a new epidermic. JAMA 1985; 232: 55-6
21. Zetta JP, Zetta P, Thanasophou B. Injury patterns in motorcycle accidents. J Trauma 1979; 19: 833-6.
22. Shih CH, Huang TJ, Chen JY, Liu HP, Hsu WR. Flexion-distraction injury of the upper thoracic spine associated with tracheoesophageal perforation. J Bone Joint Surg 2002; 84: 1028-31.
23. Odelowo EO. Pattern of trauma resulting from motorcycle accidents in Nigerians. Afr J Med Sci 1994; 23: 109-12.
24. Smith WS, Kaufer H. Pattern and mechanisms of lumbar injuries associated with    lap seat belts. J Bone Joint Surg 1969; 51A: 239-45

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Competing Interests

There were no competing interests in the preparation of this manuscript


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