Chance fracture: Difference between revisions

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==Background==
==Background==
*A type of flexion-distraction injury
*Unstable spinal fracture
*Often seen in children wearing seat-belt inappropriately (over abdomen)
**Extends horizontally posterior to anterior through the spinous process, pedicles, vertebral body
*High energy flexion  causes anterior compression w/ transverse fracture through vertebral body
*Caused by flexion-distraction forces; ex. seatbelt use in MVC
*Unstable fracture
**Upon deceleration, the spine forcibly flexes over the seatbelt, distracting (pulling apart) the middle/posterior column of spine
**Most common at T12-L2 due to spinal curvature and mechanism
*Incidence of concurrent intra-abdominal hollow viscus injuries is 50%<ref>Koay J, Davis DD, Hogg JP. Chance Fractures. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536926/</ref>
**Ex. bowel perforations and mesenteric lacerations
**Intra-abdominal injuries more commonly associated than neuro deficits
*May be misdiagnosed as anterior compression fracture (usually stable)
 
{{Vertebral fractures and dislocations types}}


==Clinical Features==
==Clinical Features==
*Seat belt sign
*Back pain and thoracolumbar midline spinal tenderness to palpation
*Chance fracture associated with 50% incidence of intra-abdominal injury
*Seatbelt sign: ecchymosis across the abdominal wall in the location of a lap belt<ref>Huecker MR, Chapman J. Seat Belt Injury. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470262/</ref>
*Most often T11 - L2
*Abdominal pain
*Lower extremity neurological deficits


==Differential Diagnosis==
==Differential Diagnosis==
*Anterior compression fracture
{{Lower back pain DDX}}
 
==Evaluation==
[[File:PchancefracX.png|thumb|Chance fracture of T10 and fracture of T9 due to a seatbelt during an MVC on xray.]]
[[File:PchancefracCT.png|thumb|Chance fracture of T10 and fracture of T9 due to a seatbelt during an MVC on CT.]]
 
===Workup===
*Obtain sagittally-reconstructed CT of thoracic and lumbar spines if suspect lap-belt mechanism or flexion-distraction
**Evaluate for retropulsion of bony fragments
*Obtain MRI to evaluate for ligamentous injuries or spinal cord injuries
*Obtain CT chest/abdomen/pelvis if suspecting intra-abdominal injuries


==Diagnosis==
===Diagnosis===
*via CT scan
*Pure bony injury from posterior to anterior through:
*Radiographs show significant distraction of middle and posterior ligamentous structures
**Spinous process
**Pedicles
**Vertebral body


==Management==
==Management==
*If no neurologic deficits present:
**Non-operative immobilization with cast or TLSO
*If neurologic deficits present:
**Surgical decompression and fixation/fusion


==Disposition==
==Disposition==
*Admit


==See Also==
==See Also==
*[[Thoracic and lumbar fractures and dislocations]]


==External Links==
==External Links==


==References==
==References==
*Tintinalli
<references/>


<references/>
[[Category:Trauma]]
[[Category:Neurology]]
[[Category:Orthopedics]]

Latest revision as of 16:04, 18 October 2023

Background

  • Unstable spinal fracture
    • Extends horizontally posterior to anterior through the spinous process, pedicles, vertebral body
  • Caused by flexion-distraction forces; ex. seatbelt use in MVC
    • Upon deceleration, the spine forcibly flexes over the seatbelt, distracting (pulling apart) the middle/posterior column of spine
    • Most common at T12-L2 due to spinal curvature and mechanism
  • Incidence of concurrent intra-abdominal hollow viscus injuries is 50%[1]
    • Ex. bowel perforations and mesenteric lacerations
    • Intra-abdominal injuries more commonly associated than neuro deficits
  • May be misdiagnosed as anterior compression fracture (usually stable)

Vertebral fractures and dislocations types

Vertebral anatomy.
Numbering order of vertebrae.

Clinical Features

  • Back pain and thoracolumbar midline spinal tenderness to palpation
  • Seatbelt sign: ecchymosis across the abdominal wall in the location of a lap belt[2]
  • Abdominal pain
  • Lower extremity neurological deficits

Differential Diagnosis

Lower Back Pain

Evaluation

Chance fracture of T10 and fracture of T9 due to a seatbelt during an MVC on xray.
Chance fracture of T10 and fracture of T9 due to a seatbelt during an MVC on CT.

Workup

  • Obtain sagittally-reconstructed CT of thoracic and lumbar spines if suspect lap-belt mechanism or flexion-distraction
    • Evaluate for retropulsion of bony fragments
  • Obtain MRI to evaluate for ligamentous injuries or spinal cord injuries
  • Obtain CT chest/abdomen/pelvis if suspecting intra-abdominal injuries

Diagnosis

  • Pure bony injury from posterior to anterior through:
    • Spinous process
    • Pedicles
    • Vertebral body

Management

  • If no neurologic deficits present:
    • Non-operative immobilization with cast or TLSO
  • If neurologic deficits present:
    • Surgical decompression and fixation/fusion

Disposition

  • Admit

See Also

External Links

References

  1. ↑ Koay J, Davis DD, Hogg JP. Chance Fractures. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536926/
  2. ↑ Huecker MR, Chapman J. Seat Belt Injury. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470262/
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