Treatment of T1 Transverse Process Fracture
Isolated T1 transverse process fractures require only conservative management with pain control and early mobilization—no spine service consultation, surgical intervention, or bracing is necessary. 1, 2, 3
Immediate Imaging Requirements
- Obtain CT imaging immediately with 1.5-2mm collimation to confirm the fracture is truly isolated and exclude associated injuries of the weight-bearing spinal columns, as plain radiographs miss critical details. 4, 5
- Screen for non-contiguous spinal injuries, which occur in 8-14% of trauma patients, with up to 31% having injuries at distant levels. 6, 5
- Evaluate for associated non-spinal injuries, particularly thoracic organ injuries, as 70% of patients with thoracolumbar transverse process fractures have concomitant visceral injuries. 7, 3
When the Fracture is Truly Isolated
If CT demonstrates an isolated transverse process fracture with no other vertebral column injuries, further spine imaging and spine service consultation are unnecessary. 1, 2, 3
- All patients with isolated transverse process fractures remain neurologically intact and mechanically stable. 1, 2, 3
- No patient with isolated transverse process fractures requires surgical intervention or bracing (97.7-100% managed without orthosis). 2, 3
- Prolonged log-roll precautions and spine consultations waste resources and delay beneficial early mobilization. 1
Conservative Treatment Protocol
Initiate the following regimen immediately after confirming isolation of the fracture:
- NSAIDs and muscle relaxants for pain control, which reduces pain from an average of 8.8/10 to 5.2/10 on visual analog scale. 8
- Flexible support corset if needed for comfort during mobilization. 8
- Early mobilization rather than prolonged immobilization, as bed rest delays recovery without benefit. 8, 1
Long-Term Outcomes
- At 6+ months follow-up, 100% of patients with isolated transverse process fractures are fully ambulatory with no persistent back pain. 2
- No delayed neurologic deficits or spinal instability develop in patients with isolated transverse process fractures. 7, 3
Critical Pitfall to Avoid
Do not prolong log-roll precautions or delay mobilization waiting for spine consultation when CT confirms an isolated transverse process fracture. The average unnecessary delay is 29 hours, which is potentially deleterious to overall patient care. 1 These fractures are mechanically stable injuries that benefit from immediate pain management and physical therapy rather than immobilization. 1, 3