Chance fracture

{{Infobox medical condition (new)

| name = Chance fracture

| image = PchancefracCT.png

| caption = A Chance fracture of T10 and fracture of T9 due to a seatbelt during an MVC.

| pronounce =

| field =

| synonyms = Chance fracture of the spine, flexion distraction fracture, lap seat belt fracture

| symptoms = Abdominal bruising, paralysis of the legs

| complications = Splenic rupture, small bowel injury, mesenteric tear

| onset =

| duration =

| types =

| causes =

| risks = Head-on motor vehicle collision in which a person is only wearing a lap belt

| diagnosis = Medical imaging (X-ray, CT scan)

| differential = Compression fracture, burst fracture

| prevention =

| treatment = Bracing, surgery

| medication =

| prognosis =

| frequency = Rare

| deaths =

}}

A Chance fracture is a type of vertebral fracture that results from excessive flexion of the spine.{{cite book |last1=Stahel |first1=Philip F. |last2=Weckbach |first2=Sebastian |editor1-last=Pape |editor1-first=Hans-Christoph |editor2-last=Jr |editor2-first=Joseph Borrelli |editor3-last=Moore |editor3-first=Ernest E. |editor4-last=Pfeifer |editor4-first=Roman |editor5-last=Stahel |editor5-first=Philip F. |title=Textbook of Polytrauma Management: A Multidisciplinary Approach |date=2022 |publisher=Springer|edition=Third |isbn=978-3-030-95906-7 |pages=245–246|chapter-url=https://books.google.com/books?id=y4NyEAAAQBAJ&dq=fracture&pg=PA245 |language=en |chapter=20. Spine fractures}}{{cite journal | vauthors = Masudi T, McMahon HC, Scott JL, Lockey AS | title = Seat belt-related injuries: A surgical perspective | journal = Journal of Emergencies, Trauma, and Shock | volume = 10 | issue = 2 | pages = 70–73 | date = 2017 | pmid = 28367011 | pmc = 5357874 | doi = 10.4103/0974-2700.201590 | doi-access = free }} Symptoms may include abdominal bruising (seat belt sign), or less commonly paralysis of the legs.{{cite journal | vauthors = Eberhardt CS, Zand T, Ceroni D, Wildhaber BE, La Scala G | title = The Seatbelt Syndrome-Do We Have a Chance?: A Report of 3 Cases With Review of Literature | journal = Pediatric Emergency Care | volume = 32 | issue = 5 | pages = 318–22 | date = May 2016 | pmid = 26087444 | doi = 10.1097/PEC.0000000000000527 | s2cid = 25657579 }}{{cite book|last1=Pope|first1=Thomas L. | name-list-style = vanc |title=Harris & Harris' Radiology of Emergency Medicine|date=2012|publisher=Lippincott Williams & Wilkins|isbn=9781451107203|page=290|url=https://books.google.com/books?id=nsiEfRmnqYgC&pg=PA290|language=en}} In around half of cases there is an associated abdominal injury such as a splenic rupture, small bowel injury, pancreatic injury, or mesenteric tear.{{cite book|last1=Yochum|first1=Terry R.|last2=Rowe|first2=Lindsay J. | name-list-style = vanc |title=essentials of skeletal radiology|date=2004|publisher=Lippincott Williams & Wilkins|page=674|url=https://books.google.com/books?id=YmQ3GGGjDhMC&pg=PA674|language=en}} Injury to the bowel may not be apparent on the first day.{{cite book|last1=Hopkins|first1=Richard|last2=Peden|first2=Carol|last3=Gandhi|first3=Sanjay | name-list-style = vanc |title=Radiology for Anaesthesia and Intensive Care|date=2009|publisher=Cambridge University Press|isbn=9781139482486|page=114|url=https://books.google.com/books?id=TKggAwAAQBAJ&pg=PA114|language=en}}

The cause is classically a head-on motor vehicle collision in which the affected person is wearing only a lap belt.{{cite web|title=Fractures of the Thoracic and Lumbar Spine|url=https://orthoinfo.aaos.org/en/diseases--conditions/fractures-of-the-thoracic-and-lumbar-spine/|website=OrthoInfo - AAOS|access-date=29 May 2018}} Being hit in the abdomen with an object like a tree or a fall may also result in this fracture pattern.{{cite book|last1=Hsu|first1=John D.|last2=Michael|first2=John W.|last3=Fisk|first3=John R. | name-list-style = vanc | collaboration = American Academy of Orthopaedic Surgeons |title=AAOS Atlas of Orthoses and Assistive Devices|date=2008|publisher=Elsevier Health Sciences|isbn=978-0323039314|page=142|url=https://books.google.com/books?id=Q738LYIlcR8C&pg=PA142|language=en}} It often involves disruption of all three columns of the vertebral body (anterior, middle, and posterior).{{cite book|last1=Marincek|first1=Borut|last2=Dondelinger|first2=Robert F. | name-list-style = vanc |title=Emergency Radiology: Imaging and Intervention|date=2007|publisher=Springer Science & Business Media|isbn=9783540689089|page=152|url=https://books.google.com/books?id=wEiHkpPth2cC&pg=PA152|language=en}} The most common area affected is the lower thoracic and upper lumbar spine.{{cite book|last1=Provenzale|first1=James M.|last2=Nelson|first2=Rendon C.|last3=Vinson|first3=Emily N. | name-list-style = vanc |title=Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion|date=2012|publisher=Lippincott Williams & Wilkins|isbn=9781451180602|page=247|url=https://books.google.com/books?id=qBswdxYj3fkC&pg=PA247|language=en}} A CT scan is recommended as part of the diagnostic work-up to detect any potential abdominal injuries. The fracture is often unstable.{{cite web|title=Wheeless' Textbook of Orthopaedics|url=http://www.wheelessonline.com/ortho/chance_fracture_of_the_spine|website=Wheeless Online|access-date=29 May 2018}}

Treatment may be conservative with the use of a brace or via surgery. The fracture is currently rare. It was first described by G. Q. Chance, a radiologist from Manchester, UK, in 1948.{{cite journal | vauthors = Chance GQ | title = Note on a type of flexion fracture of the spine | journal = The British Journal of Radiology | volume = 21 | issue = 249 | pages = 452–453 | date = September 1948 | pmid = 18878306 | doi = 10.1259/0007-1285-21-249-452 }} The fracture was more common in the 1950s and 1960s before shoulder harnesses became common.{{cite book|last1=Patel|first1=Vikas V.|last2=Burger|first2=Evalina|last3=Brown|first3=Courtney W. | name-list-style = vanc |title=Spine Trauma: Surgical Techniques|date=2010|publisher=Springer Science & Business Media|isbn=9783642036941|page=67|url=https://books.google.com/books?id=n3rSuz_5QYMC&pg=PA67|language=en}}

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.

Diagnosis

File:PchancefracX.png

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

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

History

It was first described by G. Q. Chance, an Irish radiologist in Manchester, UK, in 1948. The fracture was more common in the 1950s and 1960s before shoulder harnesses became common.

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References

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