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.

• Cervical fractures and dislocations
  • Atlanto-occipital dissociation
  • C1
    • Jefferson fracture
    • C1 isolated anterior arch fracture
    • C1 isolated posterior arch fracture
  • C2
    • Odontoid fracture
    • Hangman's fracture
  • C3-C7
    • Cervical burst fracture
    • Cervical spinous process fracture
    • Extension cervical teardrop fracture
    • Flexion cervical teardrop fracture
    • Anterior cervical wedge fracture
  • Cervical facet dislocation
  • Isolated transverse process fracture
• Thoracic and lumbar fractures and dislocations
  • Chance fracture
  • Thoracic burst fracture
  • Lumbar burst fracture
  • Isolated transverse process fracture
  • Thoracic and lumbar compression fractures

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

• Spine related
  • Acute ligamentous injury
  • Acute muscle strain
  • Disk herniation (Sciatica)
  • Degenerative joint disease
  • Spondylolithesis
  • Epidural compression syndromes
    • Spinal cord compression (non-traumatic)
    • Cauda equina syndrome
    • Conus medullaris syndrome
    • Epidural abscess (spinal)
    • Epidural hematoma (spinal)
  • Thoracic and lumbar fractures and dislocations
  • Cancer metastasis
  • Spinal stenosis
  • Transverse myelitis
  • Vertebral osteomyelitis
  • Ankylosing spondylitis
  • Spondylolisthesis
  • Discitis
• Renal disease
  • Kidney stone
  • Pyelonephritis
  • Nephrolithiasis
• Intra-abdominal
  • Abdominal aortic aneurysm
  • Ulcer perforation
  • Retrocecal appendicitis
  • Large bowel obstruction
  • Pancreatitis
• Pelvic disease
  • PID
• Other
  • Retroperitoneal hemorrhage/mass
  • Meningitis

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

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

See Also

• Thoracic and lumbar fractures and dislocations