Thoracolumbar fractures in winter sports.

Thoracolumbar fractures occur in 14% of snowmobile injuries, and 5% of Alpine and 8% of freestyle skiing injuries. Proper management of these injuries requires: an awareness that neurologic deficits (specifically genitourinary dysfunction) may be present in spite of a normal neurologic examination; radiographic evaluation that includes computed tomography for the assessment of the middle column of the spine (the key anatomic determinant of spine stability), and standard lateral radiographs of the entire spine to diagnose the 4%-5% of noncontiguous fractures that occur; an understanding of the biomechanical principles of spinal instrumentation; accurate classification of the type of injury (e.g., wedge-compression, flexion-distraction, etc.); and selection of the appropriate instrumentation (bilateral distraction, bilateral compression, or compression combined with distraction) when open reduction and internal fixation are indicated.