|Other names: Seatbelt injury, Chance fracture of the spine, flexion distraction fracture, fulcrum fracture of the lumbar spine|
|A Chance fracture of T10 and fracture of T9 due to a lapbelt during an MVC.|
|Symptoms||Abdominal bruising, abdominal trauma, neurological symptoms|
|Complications||Splenic rupture, small bowel injury, mesenteric tear|
|Risk factors||Head-on motor vehicle collision in which a person is only wearing a lap belt|
|Diagnostic method||Medical imaging (X-ray, CT scan)|
|Differential diagnosis||Compression fracture, burst fracture|
A Chance fracture, sometimes called seat-belt fracture, is a break across the vertebral body frequently associated with abdominal trauma. It is a type of spinal fracture that typically results from a sudden excessive bending forward of the mid-back over a lap belt during a motor vehicle collision (MVC), or from an intense impact to the abdomen following a fall from a height. Symptoms may include seat belt marks and abdominal injuries, or neurological symptoms.
The fracture is typically a result of a head-on vehicle collision, where the sudden slowing of speed causes a lap belt wearing passenger to suddenly be thrown forward over the belt. The hips cannot compensate as they remain held by the belt, and the vertebra becomes pulled apart. Being hit in the abdomen with an object like a tree or a fall may also result in this fracture pattern. It often involves disruption of all three columns of the vertebral body. The most common area affected is the lower thoracic and upper lumbar spine. The fracture is generally considered unstable.
Diagnosis is by medical imaging including CT scan. It may be mistaken for a simple compression fracture. Treatment may be conservative with the use of a brace or via surgery.
The fracture is rare. It was more common in the 1950s and 1960s before shoulder harnesses became common. Around half of severe abdominal injuries as a result of an MVC have an associated Chance fracture. G. Q. Chance first described the fracture in 1948.
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. In around half of cases there is an associated abdominal injury such as a splenic rupture, small bowel injury, pancreatic injury, or mesenteric tear. Injury to the bowel may not be apparent in the first day.
On plain X-ray a Chance fracture may be suspected if two spinous processes are excessively far apart.
A CT scan of the chest, abdomen, and pelvis is recommended as part of the diagnostic work-up to detect any potential abdominal injuries. MRI may also be useful. The fracture is often unstable.
It was first described by G. Q. Chance in 1948, in three cases that used a lap belt. The fracture was more common in the 1950s and 1960s before shoulder harnesses became common.
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 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 (3rd ed.). Springer. p. 246. ISBN 978-3-030-95906-7. Archived from the original on 2022-09-20. Retrieved 2022-09-17.
- ↑ 2.0 2.1 2.2 2.3 "Wheeless' Textbook of Orthopaedics". Wheeless Online. Archived from the original on 6 July 2018. Retrieved 29 May 2018.
- ↑ 3.0 3.1 "Fractures of the Thoracic and Lumbar Spine". OrthoInfo - AAOS. Archived from the original on 4 April 2019. Retrieved 29 May 2018.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Yochum, Terry R.; Rowe, Lindsay J. (2004). essentials of skeletal radiology. Lippincott Williams & Wilkins. p. 847. Archived from the original on 2022-09-20. Retrieved 2022-09-18.
- ↑ 5.0 5.1 Provenzale, James M.; Nelson, Rendon C.; Vinson, Emily N. (2012). Duke Radiology Case Review: Imaging, Differential Diagnosis, and Discussion. Lippincott Williams & Wilkins. p. 247. ISBN 9781451180602. Archived from the original on 2019-12-22. Retrieved 2018-05-29.
- ↑ 6.0 6.1 6.2 Marincek, Borut; Dondelinger, Robert F. (2007). Emergency Radiology: Imaging and Intervention. Springer Science & Business Media. p. 152. ISBN 9783540689089. Archived from the original on 2019-12-22. Retrieved 2018-05-29.
- ↑ Hsu, John D.; Michael, John W.; Fisk, John R.; Surgeons, American Academy of Orthopaedic (2008). AAOS Atlas of Orthoses and Assistive Devices. Elsevier Health Sciences. p. 142. ISBN 978-0323039314. Archived from the original on 2020-01-26. Retrieved 2018-05-29.
- ↑ 8.0 8.1 8.2 8.3 8.4 Pope, Thomas L. (2012). Harris & Harris' Radiology of Emergency Medicine. Lippincott Williams & Wilkins. p. 290. ISBN 9781451107203. Archived from the original on 2019-12-22. Retrieved 2018-05-29.
- ↑ 9.0 9.1 9.2 9.3 9.4 Patel, Vikas V.; Burger, Evalina; Brown, Courtney W. (2010). Spine Trauma: Surgical Techniques. Springer Science & Business Media. p. 67. ISBN 9783642036941. Archived from the original on 2018-06-12. Retrieved 2018-05-29.
- ↑ 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.
- ↑ Martel, José; Bueno, Angel (2008). "Fractures with names". In Pope, Thomas; Bloem, Hans L.; Beltran, Javier; Morrison, William B.; John, David (eds.). Musculoskeletal Imaging (2nd ed.). Philadelphia: Elsevier. p. 1232.e2. ISBN 978-1-4557-0813-0. Archived from the original on 2022-09-20. Retrieved 2022-09-11.
- ↑ 12.0 12.1 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.
- ↑ Hopkins, Richard; Peden, Carol; Gandhi, Sanjay (2009). Radiology for Anaesthesia and Intensive Care. Cambridge University Press. p. 114. ISBN 9781139482486. Archived from the original on 2020-01-26. Retrieved 2018-05-29.