Chance fracture (also known by the name of fracture of the spine, transverse fracture of the spine, seat belt injury) is a flexion injury of the spine. Mostly commonly seen in patients wearing lap seat belts and experiencing traffic accidents. Now-a-days its not so common due to the introduction of shoulder seat belts in 1970s, which reduces the number of chance fracture presentations in hospitals, but its still common in some situations. It was first described by Professor G. Q. Chance in 1948.
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It is a pure bony injury extending from posterior to anterior through the spinous process, pedicles, and vertebral body of the vertebral column, respectively. The most common site is the thoracolumbar junction (T12-L2), in adults and mid lumbar region in pediatric population.
Presentation of the patient
The patient mostly presents with a severe back pain and occasionally abrasions on abdomen of the seat belt. Up to 50% of Chance fractures have associated intraabdominal injuries including fractures of the pancreas; contusions or lacerations of the duodenum and mesenteric contusions or lacerations. Therefore, a complete examination of abdomen at the initial evaluation is of utmost importance.
Mostly are managed by closed reduction and immobilization but surgery is indicated when the patient is having polytrauma or very obese patients; as their size makes it difficult to undergo a closed reduction.
Urinalysis, CHEM-12, CHEM-7 and X-rays (AP and Lateral Spine). CT and MRI can be ordered but after the injury has been confirmed clinically by history or radiologically through x-ray.
The following radiographs can give you and idea of what a chance fracture is and what is its location: