Type A4 injuries

 X-ray/ CT
 Patient examination

A-type injuries are in general a failure of anterior structures under compression with intact tension band.

Type A4 is a burst fracture or sagittal split injury involving both endplates.

These injuries are similar to A3 injuries but involve both endplates. Fractures that split the vertebral body in the sagittal plane involving the posterior vertebral wall are also included in this group.

Caution: If this fracture is seen at the cervicothoracic junction, it is likely that this is part of a type B or type C injury.

X-ray/ CT

CT/radiograph images are examined to determine the fracture type.

This CT show a sagittal reconstruction of an
C7 burst A4 fracture.

For a complete classification (AOSpine Cervical classification) of the injury, and for the management decisions, the following aspects must be considered.

  1. Neurology
  2. Facet injury
  3. Clinical modifiers

Patient examination

A standardized clinical evaluation is highly recommended before fracture treatment. Moreover, specifically in Spine injuries neurological evaluation is mandatory.