The transverse processes are covered by thick muscles and fractures of this bone are rare. It may occur as an avulsion fracture due to strong contracture of the muscles. Injury may also be due to sudden extreme twisting, side bending, or by direct impact to the process itself. The injury will not cause instability of the spine or spinal cord injury.
Transverse process fractures are usually treated with a corset or brace, but not by surgery. Associated injures may occur to the abdominal viscera, retroperitoneum, and the pelvis. This is a minor injury cause by a major force. There is a frequent association with intra-abdominal injuries. If you can see the fracture on x-ray, look for the other injuries. The fracture may be missed on a routine x-ray. A CT scan is better at defining the fracture. An L5 transverse process fracture in the presence of a pelvic fracture is a predictor of pelvic fracture instability. Its presence should alert the clinician to this possibility. For example, an L5 transverse process fracture may be a sign of an unstable pelvis. It occurs due to an avulsion of the iliolumbar ligament.
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