Siminoski et al identified patients with a compression fracture of the lumbar vertebra by a change in the rib to pelvis distance measured in the midaxillary line. This may be particularly helpful in evaluating patients with asymptomatic osteoporotic fractures. The authors are from the University of Alberta in Edmonton, Canada.


Basis: fracture of the vertebral body results in kyphosis, which reduces the distance between the lower edge of the ribs (10th rib) and the pelvic rim (iliac crest).


Measurement: in the midaxillary line with the person standing straight. In the absence of scoliosis the measurements on both sides should be similar; for the implementation the average of the 2 sides is taken.


If the distance between the lower edge of the ribs and the iliac crest is > 3.6 cm, then the changes of a compression fracture is low. The authors noted that the average fingerbreadth is 1.8 cm, so this is a distance > 2 fingerbreadths.


If the distance is less than 3.6 cm, then the chances increase as the distance decreases. A person with a decreased distance should undergo imaging studies looking for vertebral fractures or other structural conditions that can explain the finding.



• The sensitivity of a cutoff at 2 fingerbreaths (3.6 cm) is 87% with a specificity of 47%. Therefore minor vertebral fractures may be missed, while other conditions may explain the finding.


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