From the Guidelines
The treatment for a non-displaced fracture of a T1 transverse process typically involves conservative management, with simple immobilization being appropriate when fracture fragments are small, nonarticular, or minimally displaced, as suggested by the American College of Foot and Ankle Surgeons 1. This approach prioritizes minimizing morbidity, mortality, and optimizing quality of life by avoiding unnecessary surgical interventions. The conservative management includes:
- Pain control with analgesics such as acetaminophen (500-1000mg every 6 hours) or NSAIDs like ibuprofen (400-600mg every 6-8 hours) for 1-2 weeks as needed
- A short period of relative rest for 1-2 weeks, followed by gradual return to activities as tolerated
- A soft collar or thoracic brace may provide comfort and stability for 2-4 weeks, though this is not always necessary
- Physical therapy should be initiated after the acute pain subsides, usually within 2-3 weeks, focusing on gentle range of motion exercises and gradual strengthening of the surrounding muscles The rationale behind this approach is that non-displaced transverse process fractures are stable injuries that heal well without surgical intervention, as they do not bear significant weight or provide spinal stability, but rather serve as attachment points for muscles and ligaments. Regular follow-up with imaging at 6-8 weeks is recommended to ensure proper healing, and patients should seek immediate medical attention if they develop new neurological symptoms like numbness, weakness, or bladder/bowel dysfunction.
From the Research
Treatment for Non-Displaced Fracture of T1 Transverse Process
- The treatment for a non-displaced fracture of a T1 (thoracic 1) transverse process is typically conservative, focusing on symptom management and stabilization 2, 3, 4.
- Nonsteroidal anti-inflammatory drugs, muscle relaxants, and flexible support corsets may be used to manage pain and promote healing 2.
- Mobilization and physical therapy can also be beneficial in restoring range of motion and reducing discomfort 2.
- Studies have shown that isolated transverse process fractures, including those at the T1 level, do not require spine service consultation or surgical intervention 3, 4.
- Conservative treatment has been found to be effective in achieving good outcomes, with most patients experiencing significant reduction in pain and improvement in functional abilities 2, 4.
- It is essential to exclude any accompanying organ injuries or other spinal injuries before initiating treatment 2, 3.