Question
We just learned 3 hours ago that our son sustained a l3 fractured vertebrae over
two weeks ago from playing High School football.  We thought he had a Kidney
injury because it hurt in that area and his urine was a dark yellow to orange the
week of the injury.  We are waiting for a referral to the sports medicine doctor
but in the mean time it is just waiting.  Should we take him to emergency for
immediate help?

Answer
Dear Leigh Ann,

The answer really depends on the type of fracture sustained.  If the fracture is to the posterior elements of the vertebral body, then it is probably stable, and not a big deal at this point.  

If the fracture is a compression fracture with less than 25% body height, this is considered to be stable as well, and they might not treat it at all except with limited activity until the fracture heals.  Over 25% compression is still a clinical decision.

But if it is a compression fracture with more than 50% of the vertebral body height, then time is of the essence, because these fractures can be stabilized and some of the lost height regained through an minimally invasive procedure called vertebroplasty or kyphoplasty.  Basically they insert a needle into the vertebra (sometimes with a balloon to inflate it, and they fill the center of the vertebra with a cement.  Long term prognosis is good, but this can only be performed when the injury is still fairly new...and it should be performed by an orthopedic surgeon or an interventional radiologist.

Bottom line is that the treatment depends on the type and severity of the fracture.  The emergency room may not do anything, because this is technically not an emergency at all, and without a more thorough understanding of the fracture, it is hard for me to say on this one.  However, piece of mind may be worth the cost and time of an extra trip to the ER alone.

Good Luck Leigh Ann, wish I had a better answer for you.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net