Spinal fractures in blunt chest trauma.

In a series of 100 consecutive patients with mediastinal hemorrhage following blunt chest trauma, fractures and dislocations of the lower cervical, thoracic, and upper lumbar spine were causative of the mediastinal hemorrhage in nine patients. Spinal injury was clinically suspected in seven patients because of quadriplegia or paraplegia. However, in the two patients who were neurologically intact a spinal injury was not clinically suspected. In the initial triage of a patient with blunt chest trauma, the supine chest radiograph can play a key role in the identification of a potentially unstable spinal injury and the prevention of subsequent spinal cord injury.