Chance fracture | |
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Other names | Chance 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. | |
Specialty | Emergency medicine |
Symptoms | Abdominal bruising, paralysis of the legs [4] |
Complications | Splenic rupture, small bowel injury, mesenteric tear [3] [5] |
Risk factors | Head-on motor vehicle collision in which a person is only wearing a lap belt [2] |
Diagnostic method | Medical imaging (X-ray, CT scan) [1] |
Differential diagnosis | Compression fracture, burst fracture [6] |
Treatment | Bracing, surgery [1] |
Frequency | Rare [7] |
A Chance fracture is a type of vertebral fracture that results from excessive flexion of the spine. [8] [9] Symptoms may include abdominal bruising ( seat belt sign), or less commonly paralysis of the legs. [4] [10] 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 on the first day. [11]
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. [12] [10] 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] [13] The fracture was more common in the 1950s and 1960s before shoulder harnesses became common. [3] [5]
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. [10]
On plain X-ray, a Chance fracture may be suspected if two spinous processes are excessively far apart. [10]
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] [10] MRI may also be useful. [10] The fracture is often unstable. [1]
It was first described by G. Q. Chance, an Irish radiologist in Manchester, UK, in 1948. [3] [13] The fracture was more common in the 1950s and 1960s before shoulder harnesses became common. [3] [5]
Chance fracture | |
---|---|
Other names | Chance 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. | |
Specialty | Emergency medicine |
Symptoms | Abdominal bruising, paralysis of the legs [4] |
Complications | Splenic rupture, small bowel injury, mesenteric tear [3] [5] |
Risk factors | Head-on motor vehicle collision in which a person is only wearing a lap belt [2] |
Diagnostic method | Medical imaging (X-ray, CT scan) [1] |
Differential diagnosis | Compression fracture, burst fracture [6] |
Treatment | Bracing, surgery [1] |
Frequency | Rare [7] |
A Chance fracture is a type of vertebral fracture that results from excessive flexion of the spine. [8] [9] Symptoms may include abdominal bruising ( seat belt sign), or less commonly paralysis of the legs. [4] [10] 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 on the first day. [11]
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. [12] [10] 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] [13] The fracture was more common in the 1950s and 1960s before shoulder harnesses became common. [3] [5]
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. [10]
On plain X-ray, a Chance fracture may be suspected if two spinous processes are excessively far apart. [10]
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] [10] MRI may also be useful. [10] The fracture is often unstable. [1]
It was first described by G. Q. Chance, an Irish radiologist in Manchester, UK, in 1948. [3] [13] The fracture was more common in the 1950s and 1960s before shoulder harnesses became common. [3] [5]