Chance fracture

Background

  • Unstable
  • Most common at T12-L2 due to spinal curvature and mechanism
  • May be misdiagnosed as anterior compression fracture, which is usually stable

Vertebral fractures and dislocations types

Vertebral anatomy.

Clinical Features

  • Common mechanism: seat belt serves as axis of rotation with failure of middle and posterior columns
  • Seat Belt Injury: lap belt worn above the pelvic bones without a shoulder harness
  • Mechanism: minor anterior vertebral compression with failure of the middle and posterior columns
  • Intra-abdominal injuries more commonly associated than neuro 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 if suspect lap-belt mechanism or flexion-distraction

Diagnosis

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

Management

Disposition

See Also

External Links

References