Medicine:Chance fracture

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Chance fracture
Other namesChance fracture of the spine,[1] flexion distraction fracture,[2] lap seat belt fracture[3]
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A Chance fracture of T10 and fracture of T9 due to a seatbelt during an MVC.
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]

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]

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

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.[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]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 "Wheeless' Textbook of Orthopaedics". http://www.wheelessonline.com/ortho/chance_fracture_of_the_spine. 
  2. ↑ 2.0 2.1 2.2 "Fractures of the Thoracic and Lumbar Spine". https://orthoinfo.aaos.org/en/diseases--conditions/fractures-of-the-thoracic-and-lumbar-spine/. 
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Yochum, Terry R.; Rowe, Lindsay J. (2004) (in en). essentials of skeletal radiology. Lippincott Williams & Wilkins. p. 674. https://books.google.com/books?id=YmQ3GGGjDhMC&pg=PA674. 
  4. ↑ 4.0 4.1 "The Seatbelt Syndrome-Do We Have a Chance?: A Report of 3 Cases With Review of Literature". Pediatric Emergency Care 32 (5): 318–22. May 2016. doi:10.1097/PEC.0000000000000527. PMID 26087444. 
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Patel, Vikas V.; Burger, Evalina; Brown, Courtney W. (2010) (in en). Spine Trauma: Surgical Techniques. Springer Science & Business Media. p. 67. ISBN 9783642036941. https://books.google.com/books?id=n3rSuz_5QYMC&pg=PA67. 
  6. ↑ 6.0 6.1 6.2 Provenzale, James M.; Nelson, Rendon C.; Vinson, Emily N. (2012) (in en). Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion. Lippincott Williams & Wilkins. p. 247. ISBN 9781451180602. https://books.google.com/books?id=qBswdxYj3fkC&pg=PA247. 
  7. ↑ 7.0 7.1 7.2 Marincek, Borut; Dondelinger, Robert F. (2007) (in en). Emergency Radiology: Imaging and Intervention. Springer Science & Business Media. p. 152. ISBN 9783540689089. https://books.google.com/books?id=wEiHkpPth2cC&pg=PA152. 
  8. ↑ Stahel, Philip F.; Weckbach, Sebastian (2022). "20. Spine fractures". in Pape, Hans-Christoph; Jr, Joseph Borrelli; Moore, Ernest E. et al. (in en). Textbook of Polytrauma Management: A Multidisciplinary Approach (Third ed.). Springer. pp. 245–246. ISBN 978-3-030-95906-7. https://books.google.com/books?id=y4NyEAAAQBAJ&dq=fracture&pg=PA245. 
  9. ↑ "Seat belt-related injuries: A surgical perspective". Journal of Emergencies, Trauma, and Shock 10 (2): 70–73. 2017. doi:10.4103/0974-2700.201590. PMID 28367011. 
  10. ↑ 10.0 10.1 10.2 10.3 10.4 10.5 Pope, Thomas L. (2012) (in en). Harris & Harris' Radiology of Emergency Medicine. Lippincott Williams & Wilkins. p. 290. ISBN 9781451107203. https://books.google.com/books?id=nsiEfRmnqYgC&pg=PA290. 
  11. ↑ Hopkins, Richard; Peden, Carol; Gandhi, Sanjay (2009) (in en). Radiology for Anaesthesia and Intensive Care. Cambridge University Press. p. 114. ISBN 9781139482486. https://books.google.com/books?id=TKggAwAAQBAJ&pg=PA114. 
  12. ↑ Hsu, John D.; Michael, John W.; Fisk, John R. (2008) (in en). AAOS Atlas of Orthoses and Assistive Devices. Elsevier Health Sciences. p. 142. ISBN 978-0323039314. https://books.google.com/books?id=Q738LYIlcR8C&pg=PA142. 
  13. ↑ 13.0 13.1 "Note on a type of flexion fracture of the spine". The British Journal of Radiology 21 (249): 452–453. September 1948. doi:10.1259/0007-1285-21-249-452. PMID 18878306. 

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