1612. Isolated Transverse Process Fractures: Conservative Management Protocol at a University Level 1 Trauma Center

Authors: Dillon Dejam; Komal Preet, BS; Methma Udawatta, BS; Prasanth Romiyo, BS; Alexander Tucker, MD; Tianyi Niu, MD; Daniel Nagasawa, MD; Isaac Yang, MD (Tujunga, CA)

Introduction: Isolated transverse process fractures (ITPFs) are injuries of single or multiple transverse processes, without extension into other regions of the vertebrae. Our previous studies suggest that ITPFs do not result in spinal instability or neurological deficit, and should thus be treated conservatively without any bracing or surgical intervention. As such, we initiated a protocol eliminating the necessity for bracing or consultation with a Spine Specialist for cases of ITPFs at our University level 1 trauma center. Methods: A prospective study was designed to evaluate protocol compliance and patient outcome for those with ITPFs treated at the Ronald Reagan UCLA Medical Center between August 2016 and August 2017. Results: Twenty-one patients were identified with ITPFs. The mean age of the patients was 49 years (range 17-84). The most common mechanism of injury was motor vehicle accident (n=18, 86%), followed by fall (n=3, 14%). The most common presenting symptom was back pain (n=9, 43%). Of the 21 patients, 14 (67%) underwent consult of a spine specialist. A Welch two-sample t-test indicated that patients who received a spinal consult spent significantly more time in the hospital than patients who did not (p=0.04), despite no significant difference in the Injury Severity Score of these two groups (p=0.138). Management of ITPFs was nonsurgical, with 5 patients (24%) prescribed bracing. At last follow up, none of the patients presented with ITPF-associated complications or neurological deficits. Conclusion: ITPFs are stable injuries, with promising outcomes at follow up. The results in this study provide evidence for the efficacy of conservative, non-surgical treatment for ITPFs, and affirm that Spine Specialist consultation is not necessary. However, given the long history of reflexive consultation for these injuries, further education regarding optimal management will be required to reduce delays in patient disposition, eliminate unnecessary bracing, and improve patient care.