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Chance Fracture
Blaise V. Jones, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Synonyms

            • Flexion-distraction injury, seat belt fracture
          • Definitions

            • Compression injury of anterior column of spine with distraction of middle & posterior columns
              • Anterior column: Anterior longitudinal ligament (ALL), anterior 1/2 of vertebral body, anterior annulus fibrosis
              • Middle column: Posterior longitudinal ligament, posterior 1/2 of vertebral body, posterior annulus fibrosis
              • Posterior column: Posterior neural arch, facet joint capsular ligaments, ligamentum flavum, inter- & supraspinous ligaments

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Lawson BK et al: Cauda equina and conus medullaris avulsion with herniation after midlumbar chance fracture. Spine J. 14(6):1060-2, 2014
                                    2. Daniels AH et al: Pediatric thoracolumbar spine trauma. J Am Acad Orthop Surg. 21(12):707-16, 2013
                                    3. Suttor S et al: Operative treatment of chance injuries in the paediatric population. Eur Spine J. 22(3):510-4, 2013
                                    4. Arkader A et al: Pediatric Chance fractures: a multicenter perspective. J Pediatr Orthop. 31(7):741-4, 2011
                                    5. Seitz H et al: Adolescent lumbar chance lesion: recurrent instability after hardware removal. J Trauma. 68(1):E16-9, 2010
                                    6. Gordon ZL et al: Three siblings with Chance fractures: the importance of 3-point restraints. J Pediatr Orthop. 29(8):856-9, 2009
                                    7. Tillou A et al: Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation. J Trauma. 67(4):779-87, 2009
                                    8. Mulpuri K et al: The spectrum of abdominal injuries associated with chance fractures in pediatric patients. Eur J Pediatr Surg. 17(5):322-7, 2007
                                    9. Bernstein MP et al: Chance-type fractures of the thoracolumbar spine: imaging analysis in 53 patients. AJR Am J Roentgenol. 187(4):859-68, 2006
                                    10. Choit RL et al: Abdominal aortic injuries associated with chance fractures in pediatric patients. J Pediatr Surg. 41(6):1184-90, 2006
                                    11. Groves CJ et al: Chance-type flexion-distraction injuries in the thoracolumbar spine: MR imaging characteristics. Radiology. 236(2):601-8, 2005
                                    12. Hsu JM et al: Thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging. Injury. 34(6):426-33, 2003
                                    13. Liu YJ et al: Flexion-distraction injury of the thoracolumbar spine. Injury. 34(12):920-3, 2003
                                    14. Sheridan R et al: Reformatted visceral protocol helical computed tomographic scanning allows conventional radiographs of the thoracic and lumbar spine to be eliminated in the evaluation of blunt trauma patients. J Trauma. 55(4):665-9, 2003
                                    15. Wintermark M et al: Thoracolumbar spine fractures in patients who have sustained severe trauma: depiction with multi-detector row CT. Radiology. 227(3):681-9, 2003
                                    16. Beaunoyer M et al: Abdominal injuries associated with thoraco-lumbar fractures after motor vehicle collision. J Pediatr Surg. 36(5):760-2, 2001
                                    17. Greenwald TA et al: Pediatric seatbelt injuries: diagnosis and treatment of lumbar flexion-distraction injuries. Paraplegia. 32(11):743-51, 1994
                                    18. Reid AB et al: Pediatric Chance fractures: association with intra-abdominal injuries and seatbelt use. J Trauma. 30(4):384-91, 1990
                                    19. Rogers LF: The roentgenographic appearance of transverse or chance fractures of the spine: the seat belt fracture. Am J Roentgenol Radium Ther Nucl Med. 111(4):844-9, 1971
                                    20. Chance GQ: Note on a type of flexion fracture of the spine. Br J Radiol. 21(249):452, 1948
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Clinical Issues

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Synonyms

                                              • Flexion-distraction injury, seat belt fracture
                                            • Definitions

                                              • Compression injury of anterior column of spine with distraction of middle & posterior columns
                                                • Anterior column: Anterior longitudinal ligament (ALL), anterior 1/2 of vertebral body, anterior annulus fibrosis
                                                • Middle column: Posterior longitudinal ligament, posterior 1/2 of vertebral body, posterior annulus fibrosis
                                                • Posterior column: Posterior neural arch, facet joint capsular ligaments, ligamentum flavum, inter- & supraspinous ligaments

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • CT Findings

                                                  • MR Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Staging, Grading, & Classification

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Demographics

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Lawson BK et al: Cauda equina and conus medullaris avulsion with herniation after midlumbar chance fracture. Spine J. 14(6):1060-2, 2014
                                                                      2. Daniels AH et al: Pediatric thoracolumbar spine trauma. J Am Acad Orthop Surg. 21(12):707-16, 2013
                                                                      3. Suttor S et al: Operative treatment of chance injuries in the paediatric population. Eur Spine J. 22(3):510-4, 2013
                                                                      4. Arkader A et al: Pediatric Chance fractures: a multicenter perspective. J Pediatr Orthop. 31(7):741-4, 2011
                                                                      5. Seitz H et al: Adolescent lumbar chance lesion: recurrent instability after hardware removal. J Trauma. 68(1):E16-9, 2010
                                                                      6. Gordon ZL et al: Three siblings with Chance fractures: the importance of 3-point restraints. J Pediatr Orthop. 29(8):856-9, 2009
                                                                      7. Tillou A et al: Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation. J Trauma. 67(4):779-87, 2009
                                                                      8. Mulpuri K et al: The spectrum of abdominal injuries associated with chance fractures in pediatric patients. Eur J Pediatr Surg. 17(5):322-7, 2007
                                                                      9. Bernstein MP et al: Chance-type fractures of the thoracolumbar spine: imaging analysis in 53 patients. AJR Am J Roentgenol. 187(4):859-68, 2006
                                                                      10. Choit RL et al: Abdominal aortic injuries associated with chance fractures in pediatric patients. J Pediatr Surg. 41(6):1184-90, 2006
                                                                      11. Groves CJ et al: Chance-type flexion-distraction injuries in the thoracolumbar spine: MR imaging characteristics. Radiology. 236(2):601-8, 2005
                                                                      12. Hsu JM et al: Thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging. Injury. 34(6):426-33, 2003
                                                                      13. Liu YJ et al: Flexion-distraction injury of the thoracolumbar spine. Injury. 34(12):920-3, 2003
                                                                      14. Sheridan R et al: Reformatted visceral protocol helical computed tomographic scanning allows conventional radiographs of the thoracic and lumbar spine to be eliminated in the evaluation of blunt trauma patients. J Trauma. 55(4):665-9, 2003
                                                                      15. Wintermark M et al: Thoracolumbar spine fractures in patients who have sustained severe trauma: depiction with multi-detector row CT. Radiology. 227(3):681-9, 2003
                                                                      16. Beaunoyer M et al: Abdominal injuries associated with thoraco-lumbar fractures after motor vehicle collision. J Pediatr Surg. 36(5):760-2, 2001
                                                                      17. Greenwald TA et al: Pediatric seatbelt injuries: diagnosis and treatment of lumbar flexion-distraction injuries. Paraplegia. 32(11):743-51, 1994
                                                                      18. Reid AB et al: Pediatric Chance fractures: association with intra-abdominal injuries and seatbelt use. J Trauma. 30(4):384-91, 1990
                                                                      19. Rogers LF: The roentgenographic appearance of transverse or chance fractures of the spine: the seat belt fracture. Am J Roentgenol Radium Ther Nucl Med. 111(4):844-9, 1971
                                                                      20. Chance GQ: Note on a type of flexion fracture of the spine. Br J Radiol. 21(249):452, 1948