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
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
- Thoracic and lumbar fractures and dislocations
- Cancer metastasis
- Spinal stenosis
- Transverse myelitis
- Vertebral osteomyelitis
- Ankylosing spondylitis
- Spondylolisthesis
- Discitis
- Renal disease
- Intra-abdominal
- Abdominal aortic aneurysm
- Ulcer perforation
- Retrocecal appendicitis
- Large bowel obstruction
- Pancreatitis
- Pelvic disease
- PID
- Other
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
Disposition
External Links
References
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