Chance fracture

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 namesChance 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.
SpecialtyEmergency medicine 
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]

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. "Wheeless' Textbook of Orthopaedics". Wheeless Online. Retrieved 29 May 2018.
  2. "Fractures of the Thoracic and Lumbar Spine". OrthoInfo - AAOS. Retrieved 29 May 2018.
  3. Yochum TR, Rowe LJ (2004). essentials of skeletal radiology. Lippincott Williams & Wilkins. p. 674.
  4. Eberhardt CS, Zand T, Ceroni D, Wildhaber BE, La Scala G (May 2016). "The Seatbelt Syndrome-Do We Have a Chance?: A Report of 3 Cases With Review of Literature". Pediatric Emergency Care. 32 (5): 318–22. doi:10.1097/PEC.0000000000000527. PMID 26087444. S2CID 25657579.
  5. Patel VV, Burger E, Brown CW (2010). Spine Trauma: Surgical Techniques. Springer Science & Business Media. p. 67. ISBN 9783642036941.
  6. Provenzale JM, Nelson RC, Vinson EN (2012). Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion. Lippincott Williams & Wilkins. p. 247. ISBN 9781451180602.
  7. Marincek B, Dondelinger RF (2007). Emergency Radiology: Imaging and Intervention. Springer Science & Business Media. p. 152. ISBN 9783540689089.
  8. Stahel, Philip F.; Weckbach, Sebastian (2022). "20. Spine fractures". In Pape, Hans-Christoph; Jr, Joseph Borrelli; Moore, Ernest E.; Pfeifer, Roman; Stahel, Philip F. (eds.). Textbook of Polytrauma Management: A Multidisciplinary Approach (Third ed.). Springer. pp. 245–246. ISBN 978-3-030-95906-7.
  9. Masudi T, McMahon HC, Scott JL, Lockey AS (2017). "Seat belt-related injuries: A surgical perspective". Journal of Emergencies, Trauma, and Shock. 10 (2): 70–73. doi:10.4103/0974-2700.201590. PMC 5357874. PMID 28367011.
  10. Pope TL (2012). Harris & Harris' Radiology of Emergency Medicine. Lippincott Williams & Wilkins. p. 290. ISBN 9781451107203.
  11. Hopkins R, Peden C, Gandhi S (2009). Radiology for Anaesthesia and Intensive Care. Cambridge University Press. p. 114. ISBN 9781139482486.
  12. Hsu JD, Michael JW, Fisk JR, et al. (American Academy of Orthopaedic Surgeons) (2008). AAOS Atlas of Orthoses and Assistive Devices. Elsevier Health Sciences. p. 142. ISBN 978-0323039314.
  13. Chance GQ (September 1948). "Note on a type of flexion fracture of the spine". The British Journal of Radiology. 21 (249): 452–453. doi:10.1259/0007-1285-21-249-452. PMID 18878306.
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