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The aim of the paper is to identify the of optimal plastic type used in obtaining thoraco-lumbar orthoses - used in the treatments of comminutive fracture, of burst fracture type of the vertebrae in the lumbar area. For this purpose, with the help of Finite Element Analysis (FEA), a theoretical study was carried out on the influence of elastic properties of plastics, used in the achieving of lumbar orthoses, on the state of tension and on the local displacements of the bone fragments from the traumatized area under the condition of the movement from the base of extension and flexion. In the study the force of flexion, the force of extension and the elastic modulus of plastic material varied on three levels. The theoretical results obtained were completed with clinical trials carried out on a total of 26 patients who suffer thoraco-lumbar comminutive fracture, burst fractures type, at vertebra T11 and were immobilized in Boston-type plastic orthoses made of: polypropylene (PP), rigid vinyl polychloride (PVC-D) and polytetrafluoroethylene (PTFE). As a result of observations, it was found that the use of an orthesis made from rigid plastic material, although it appears higher stresses in the traumatized zone, the displacements of bone fragments are smaller, the pains is higher in the fractured zone, the angle of kyphosis (LKA) close to the normal value and a better mobility of the spine (ODI indicator).

In this paper it is presented a comparative theoretical study - performed by finite element analysis (FEA), of the tension state that appears at the level of the spine, as well as in the areas adjacent to it, under the following conditions: a) the existence of a comminutive fracture at the level of the vertebra T11; b) of the external immobilization of the body through a Lombax orthesis (LO) or of the internal immobilization of the column by means of a spinal fixator (SF); c) of performing some basic flexion or extension movements. In this study, both flexural force and extension force varied on three levels. The results of the comparative theoretical study were supplemented with the clinical observations obtained from a number of 52 patients who had suffered comminutive fractures in the T11 vertebra and who were treated - by external immobilization, in the Lombax orthesis or were surgically treated - by applying a trapped spinal fixator on the T10-T12 vertebrae. The study had demonstrated that, by immobilizing the body in the Lombax orthesis, following the application of the flexion or extension movement, the mobility of the body is low, the bone fragments move less distances by about 12% against to their displacement under the condition of immobilizing the column by a spinal fixator. Although, in the latter case, the displacements of the bone fragments are greater, the elastic behaviour of the spinal fixator determines the returning of the fragments and of the spine to the initial position as well as the distance between the vertebrae. Clinical investigations on patients treated by external immobilization of the body in the Lombax orthesis show that the values of the local kyphosis angle (LKA) are about 30% lower than the values of the same parameter obtained under the surgical treatment.

Thoraco-lumbar fracture-dislocations represent one of the most instable lesions and are frequently associated with neurological deficit. We present a patient with a T11 - T12 fracture-dislocation with complete neurological deficit - ASIA - A, who underwent partial vertebrectomy, shortening of the spine and posterior instrumentation 21 days after a motor vehicle accident.