The Denis three-column concept classifies thoracolumbar fractures. An anterior compression fracture of >50% height loss with middle column intact represents which Denis type and what is the clinical implication?
- A Wedge compression fracture — middle column intact, anterior failure only, potentially stable ✓
- B Burst fracture — posterior column disruption, unstable, requires surgery
- C Flexion-distraction injury (Chance fracture) — posterior column failure in tension
- D Fracture-dislocation — all three columns disrupted
Explanation
In Denis classification, a wedge compression fracture involves failure of only the anterior column (anterior vertebral body compresses) while the middle column (posterior body wall and posterior longitudinal ligament) remains intact. Mechanically, the intact middle column acts as a hinge and provides stability, making isolated anterior column fractures potentially stable and amenable to conservative management (hyperextension bracing or bed rest). When anterior height loss exceeds 50% or kyphosis exceeds 30°, risk of progressive collapse increases. Burst fractures involve both anterior and middle columns (retropulsion of bone into canal); Chance fractures involve posterior and middle columns in tension.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.