Several authors have reported on lumbar Chance fractures associated with lap type seat-belts. Flexion-distraction forces generated by hyperflexion of the spine over a fulcrum are responsible for the Chance fracture. The Chance fracture consists of a horizontal splitting of the spine and the neural arch of vertebra, propagating from the posterior spinal elements to the anterior vertebral body, with no lateral displacement or rotation of the fracture fragments. However, this case reports a 30 year old male, involved in a high velocity motor vehicle accident, sustaining a Chance fracture of the thoracic spine in a hyperflexion type of injury, without wearing a seatbelt. Such fractures have been reported in adults and very rarely in children and are associated with motor vehicle injuries where a lap type seatbelt is worn. The proposed mechanism involves a hyperflexion injury. Transverse fractures of the vertebra are described as Chance fractures. Upon completion of treatment, he returned successfully to pre-injury levels of daily activity, without any impairment. At the 5th month follow-up, he was pain free with radiographic signs of mild vertebral kyphosis. The thoracolumbar orthosis was applied for three months. The patient was followed up with serial thoracolumbar radiographs for the first 6 weeks of ambulation and later on, in one month intervals. Appropriate antithrombotic prophylaxis with low molecular weight heparin was administered, until full ambulation was achieved. Conservative treatment was decided and the patient, following an initial period of bed rest, was mobilized wearing a thoracolumbar orthosis. The CT scan further demonstrated a split of the posterior elements, progressing anteriorly into the vertebral body. 3 3) of the thoracolumbar spine revealed a transverse fracture at the level of T12. Simple radiographic evaluation of the cervical spine, thorax and pelvis did not demonstrate associated injuries. Ultrasonography was performed to exclude blunt abdominal concomitant injuries. His neurologic examination was normal with no motor or sensory deficit of the lower and upper limbs. Upon admission, palpation revealed tenderness at the thoracolumbar region. During admission, his primary complain was back pain. He was at the driver's seat and did not wear a seatbelt. X-ray may underestimate the extent of injury and so if there has been high risk injury or other suspicion of instability then CT should be considered.A 30-year-old male was involved in an automobile accident. Although considered 'stable' the greater the loss of height anteriorly the greater the risk of middle column involvement. RULE: If you see one fracture - check for another 1 Column - Anterior compression injuryĪnterior compression injury is a common fracture pattern which results from traumatic hyper-flexion with compression. If a 2 column injury is seen then likelihood of a second fracture increases to 40%. If an injury is seen which disrupts 1 column then a second fracture is also present in approximately 15% of cases. If the middle column is seen to be injured it is usually taken that another column must be injured even if no anterior or posterior column fracture is visible. Spinal injuries which are seen to disrupt structures of 2 or more columns are considered 'unstable'. This page also discusses osteoporotic fractures, and fractures of the transverse and spinous processes. The 'three column model' (see previous page) can be used to form a basic classification of thoracolumbar spinal injuries (see box). ![]() 3 column - Flexion-distraction 'Chance-type' injuriesĪ good understanding of normal appearances and a systematic approach are required for assessment of the T-spine and the L-spine (see previous page).1 column - Anterior compression (or isolated spinous process injuries).Spacing - Discs/Spinous processes/Pediclesīasic thoracolumbar spine injury classification.Bones - Cortical outline/Vertebral body height.Thoracolumbar spine - Systematic approach If you see one fracture - check for another.If 'instability' is suspected then further imaging with CT should be considered.Correlate radiological findings with the clinical features.
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