Detecting Compression Fracture of a Lumbar Vertebra Based on the Rib to Pelvis Distance in the Midaxillary Line

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.

Performance:

• 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.