Chance fracture

A Chance fracture is a type of vertebral fracture that results from excessive flexion of the spine.[8] Symptoms may include abdominal bruising (seat belt sign), or less commonly paralysis of the legs.[4][9] In around half of cases there is an associated abdominal injury such as a splenic rupture, small bowel injury, pancreatic injury, or mesenteric tear.[3][5] Injury to the bowel may not be apparent in the first day.[10]

Chance fracture
Other namesChance fracture of the spine,[1] flexion distraction fracture,[2] lap seat belt fracture[3]
A Chance fracture of T10 and fracture of T9 due to a seatbelt during an MVC.
SpecialtyEmergency medicine 
SymptomsAbdominal bruising, paralysis of the legs[4]
ComplicationsSplenic rupture, small bowel injury, mesenteric tear[3][5]
Risk factorsHead-on motor vehicle collision in which a person is only wearing a lap belt[2]
Diagnostic methodMedical imaging (X-ray, CT scan)[1]
Differential diagnosisCompression fracture, burst fracture[6]
TreatmentBracing, surgery[1]
FrequencyRare[7]

The cause is classically a head-on motor vehicle collision in which the affected person is wearing only a lap belt.[2] Being hit in the abdomen with an object like a tree or a fall may also result in this fracture pattern.[11][9] It often involves disruption of all three columns of the vertebral body (anterior, middle, and posterior).[7][6] The most common area affected is the lower thoracic and upper lumbar spine.[6] A CT scan is recommended as part of the diagnostic work-up to detect any potential abdominal injuries.[5] The fracture is often unstable.[1]

Treatment may be conservative with the use of a brace or via surgery.[1] The fracture is currently rare.[7] It was first described by G. Q. Chance, a radiologist from Manchester, UK, in 1948.[3][12] The fracture was more common in the 1950s and 1960s before shoulder harnesses became common.[3][5]

Mechanism

In some Chance fractures there is a transverse break through the bony spinous process while in others there is a tear of the supraspinous ligament, ligamentum flavum, interspinous ligament, and posterior longitudinal ligament.[9]

Diagnosis
A flexion-distraction fracture of T10 and fracture of T9 due to a seatbelt during an MVC.

On plain X-ray a Chance fracture may be suspected if two spinous processes are excessively far apart.[9]

A CT scan of the chest, abdomen, and pelvis is recommended as part of the diagnostic work-up to detect any potential abdominal injuries.[5][9] MRI may also be useful.[9] The fracture is often unstable.[1]

History

It was first described by G. Q. Chance, a radiologist from Manchester, UK, in 1948.[3][12] The fracture was more common in the 1950s and 1960s before shoulder harnesses became common.[3][5]

References
  1. "Wheeless' Textbook of Orthopaedics". Wheeless Online. Retrieved 29 May 2018.
  2. "Fractures of the Thoracic and Lumbar Spine". OrthoInfo - AAOS. Retrieved 29 May 2018.
  3. Yochum, Terry R.; Rowe, Lindsay J. (2004). essentials of skeletal radiology. Lippincott Williams & Wilkins. p. 674.
  4. Eberhardt, CS; Zand, T; Ceroni, D; Wildhaber, BE; La Scala, G (May 2016). "The Seatbelt Syndrome-Do We Have a Chance?: A Report of 3 Cases With Review of Literature". Pediatric Emergency Care. 32 (5): 318–22. doi:10.1097/PEC.0000000000000527. PMID 26087444.
  5. Patel, Vikas V.; Burger, Evalina; Brown, Courtney W. (2010). Spine Trauma: Surgical Techniques. Springer Science & Business Media. p. 67. ISBN 9783642036941.
  6. Provenzale, James M.; Nelson, Rendon C.; Vinson, Emily N. (2012). Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion. Lippincott Williams & Wilkins. p. 247. ISBN 9781451180602.
  7. Marincek, Borut; Dondelinger, Robert F. (2007). Emergency Radiology: Imaging and Intervention. Springer Science & Business Media. p. 152. ISBN 9783540689089.
  8. Masudi, T; McMahon, HC; Scott, JL; Lockey, AS (2017). "Seat belt-related injuries: A surgical perspective". Journal of Emergencies, Trauma, and Shock. 10 (2): 70–73. doi:10.4103/0974-2700.201590. PMC 5357874. PMID 28367011.
  9. Pope, Thomas L. (2012). Harris & Harris' Radiology of Emergency Medicine. Lippincott Williams & Wilkins. p. 290. ISBN 9781451107203.
  10. Hopkins, Richard; Peden, Carol; Gandhi, Sanjay (2009). Radiology for Anaesthesia and Intensive Care. Cambridge University Press. p. 114. ISBN 9781139482486.
  11. Hsu, John D.; Michael, John W.; Fisk, John R.; Surgeons, American Academy of Orthopaedic (2008). AAOS Atlas of Orthoses and Assistive Devices. Elsevier Health Sciences. p. 142. ISBN 978-0323039314.
  12. Chance, GQ (September 1948). "Note on a type of flexion fracture of the spine". The British Journal of Radiology. 21 (249): 452–453. doi:10.1259/0007-1285-21-249-452. PMID 18878306.
Classification
External resources
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