What is the treatment for a transverse process fracture?

Treatment of Transverse Process Fractures

Transverse process fractures should be treated conservatively with NSAIDs, muscle relaxants, flexible support corsets, and early mobilization—spine consultation and prolonged immobilization are unnecessary when adequate CT imaging excludes associated vertebral column injuries. 1, 2

Initial Diagnostic Approach

• Obtain helical CT scan of the thoracolumbar spine to definitively identify the fracture and exclude associated weight-bearing column injuries, as plain radiographs frequently miss these fractures 3, 2
• Rule out associated injuries: 17% of transverse process fractures have concurrent significant vertebral fractures, and visceral injuries (particularly renal, hepatic, or splenic) are common with the trauma mechanism 2
• Once CT confirms isolated transverse process fracture with no weight-bearing column involvement, no further imaging or spine consultation is needed 2

Conservative Treatment Protocol

Pain Management:

• Administer NSAIDs and muscle relaxants as first-line therapy 1
• Expected pain reduction from 8.8/10 to 5.2/10 on visual analog scale within days of treatment initiation 1
• For refractory pain after >1 week of conservative management, consider CT-guided fracture site in situ block with local anesthetic and steroids, which allows immediate return to activities in 75% of cases 4

Immobilization:

• Use flexible support corsets for comfort, not rigid bracing 1
• Avoid prolonged log-roll precautions—these waste resources and delay mobilization when CT excludes other injuries 2
• Limit immobilization to <48 hours once isolated transverse process fracture is confirmed 2

Mobilization:

• Begin early mobilization immediately after excluding associated injuries 1, 2
• Physical therapy should focus on gradual return to activity 2

Common Pitfalls to Avoid

• Do not order unnecessary spine consultations when screening CT shows isolated transverse process fractures—this leads to average 29-hour delays in mobilization without identifying additional injuries 2
• Do not perform spinal manipulation until fracture is definitively excluded by imaging, as this occurred inappropriately in one case series 3
• Carefully review all vertebral levels on CT—one patient had persistent pain after L4 fracture site block because an L1 fracture was initially missed 4
• Do not rush return to contact sports—allow minimum 4 weeks healing before resuming high-impact activities 3

Expected Recovery Timeline

• Pain improvement within days of initiating conservative treatment 1
• Return to daily activities within 1-4 weeks depending on fracture severity and patient factors 1, 3
• Return to contact sports after 4 weeks minimum 3