Chance fracture
Medical condition
From Wikipedia, the free encyclopedia
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]
| 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] |
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]
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.[10]
Diagnosis
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]
History
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]