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}}