A patient with ankylosing spondylitis (AS) suffers a minor fall and complains of severe neck pain. A CT scan shows a fracture through the C6–C7 disc space traversing both cortices of the ankylosed spine. The mechanism and management concern is:

• A A chalk-stick (transverse) fracture through the rigid ankylosed column; highly unstable, three-column injury requiring posterior instrumentation and fusion ✓
• B An osteoporotic compression fracture; managed conservatively with a collar
• C A clay-shoveller fracture of the spinous process; conservative management
• D An odontoid fracture type II; halo vest immobilisation

Explanation

In ankylosing spondylitis the entire spinal column behaves as a long bone — a 'chalk stick'. Even minor trauma causes transverse fractures through the disc or vertebral body that propagate through all three columns, producing catastrophic instability. These injuries are associated with high rates of epidural haematoma and spinal cord injury. Posterior long-segment instrumented fusion (spanning at least 3 levels above and below) is required; simple collar or conservative management is inadequate for these unstable three-column fractures.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.