Chance Fracture eMedicine Orthopedics

Description: Patients complaining of back pain following motor vehicle accidents or falls from significant heights should be considered to have spinal injuries until proven otherwise. With flexion-distraction mechanisms such as those observed in passengers restrained with lap seatbelts, a progression of injury from the posterior column of the thoracolumbar spine is observed anteriorly. When this involves only the osseous structures, a Chance injury exists. The diagnosis is best made on good quality radiographs obtained in 2 planes (anteroposterior [AP] and lateral). Prompt recognition followed by appropriate reduction and immobilization usually results in a good clinical outcome. Always exclude associated injuries (eg, intra-abdominal trauma) at the time of presentation, as these are observed in up to 50% of cases, particularly in children.
Synonyms and related keywords: flexion-distraction injury, thoracolumbar spine injury Author: Jacob Goodrich, MD 2005