Chance fracture

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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/