My achin’ back: Vertebral compression fractures

Case presentation

A 9-year-old female seeks care after falling from her bicycle. She states that she was riding her bike and attempted to “pop a wheelie.” In doing so, she fell backward, separating herself from the bike, landing initially on her buttocks, but then onto her back. There is no reported loss of consciousness and she was wearing a helmet. She denies neck pain. She did not strike the handlebars and has no chest or abdominal pain.

Her physical examination reveals no fever, a heart rate of 100 beats per minute, a blood pressure of 105/54 mm Hg, and room air oxygen saturations of 99%. She has no outward signs of trauma. There is no chest or abdominal tenderness. Her pelvis is stable and nontender. She complains of diffuse tenderness around her mid-thoracic spine but cannot pinpoint a precise location of pain. There are no obvious external signs of trauma (i.e., no hematoma, bruising, or abrasion) and there are no step-offs, crepitus, or deformities. Her extremities have no signs of trauma. She is able to ambulate but complains of mid-thoracic back pain. She is grossly neurovascularly intact.

Imaging considerations