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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Diagnostic Checklist
TERMINOLOGY
Synonyms
- Flexion-distraction injury, seat belt fracture
Definitions
- Compression injury of anterior column with distraction of middle and posterior columns
- Anterior column: Anterior longitudinal ligament (ALL), anterior 1/2 of vertebral body, anterior annulus fibrosis
- Middle column: Posterior longitudinal ligament (PLL), posterior 1/2 of vertebral body, posterior annulus fibrosis
- Posterior column: Posterior neural arch, facet joint capsular ligaments, ligamentum flavum, inter- and supraspinous ligaments
- Transitional zone: T11-L1 vertebrae, highly susceptible to fracture
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
- García-Pérez D et al: Occult thoracic disco-ligamentous Chance fracture in computed tomography: a case report. Eur Spine J. ePub, 2020
- Andras LM et al: Chance fractures in the pediatric population are often misdiagnosed. J Pediatr Orthop. 39(5):222-5, 2019
- Bourghli A et al: Management of a high thoracic chance fracture. Eur Spine J. 27(7):1547-52, 2018
- Damar Ç et al: A Chance fracture and accompanying injuries secondary to seat belt trauma in childhood. Spine J. 16(10):e647-8, 2016
- Khurana B et al: Traumatic thoracolumbar spine injuries: what the spine surgeon wants to know. Radiographics. 33(7):2031-46, 2013
- Pizones J et al: Prospective analysis of magnetic resonance imaging accuracy in diagnosing traumatic injuries of the posterior ligamentous complex of the thoracolumbar spine. Spine (Phila Pa 1976). 38(9):745-51, 2013
- Lenarz CJ et al: Comparative reliability of 3 thoracolumbar fracture classification systems. J Spinal Disord Tech. 22(6):422-7, 2009
- 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
- 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
- Groves CJ et al: Chance-type flexion-distraction injuries in the thoracolumbar spine: MR imaging characteristics. Radiology. 236(2):601-8, 2005
- Hsu JM et al: Thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging. Injury. 34(6):426-33, 2003
- Liu YJ et al: Flexion-distraction injury of the thoracolumbar spine. Injury. 34(12):920-3, 2003
- Sapkas GS et al: Thoracic spinal injuries: operative treatments and neurologic outcomes. Am J Orthop. 32(2):85-8, 2003
- 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
- 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
- Beaunoyer M et al: Abdominal injuries associated with thoraco-lumbar fractures after motor vehicle collision. J Pediatr Surg. 36(5):760-2, 2001
- Greenwald TA et al: Pediatric seatbelt injuries: diagnosis and treatment of lumbar flexion-distraction injuries. Paraplegia. 32(11):743-51, 1994
- Anderson PA et al: Flexion distraction and chance injuries to the thoracolumbar spine. J Orthop Trauma. 5(2):153-60, 1991
- Reid AB et al: Pediatric Chance fractures: association with intra-abdominal injuries and seatbelt use. J Trauma. 30(4):384-91, 1990
- 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
- Chance GQ: Note on a type of flexion fracture of the spine. Br J Radiol. 21(249):452, 1948
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Diagnostic Checklist
TERMINOLOGY
Synonyms
- Flexion-distraction injury, seat belt fracture
Definitions
- Compression injury of anterior column with distraction of middle and posterior columns
- Anterior column: Anterior longitudinal ligament (ALL), anterior 1/2 of vertebral body, anterior annulus fibrosis
- Middle column: Posterior longitudinal ligament (PLL), posterior 1/2 of vertebral body, posterior annulus fibrosis
- Posterior column: Posterior neural arch, facet joint capsular ligaments, ligamentum flavum, inter- and supraspinous ligaments
- Transitional zone: T11-L1 vertebrae, highly susceptible to fracture
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
- García-Pérez D et al: Occult thoracic disco-ligamentous Chance fracture in computed tomography: a case report. Eur Spine J. ePub, 2020
- Andras LM et al: Chance fractures in the pediatric population are often misdiagnosed. J Pediatr Orthop. 39(5):222-5, 2019
- Bourghli A et al: Management of a high thoracic chance fracture. Eur Spine J. 27(7):1547-52, 2018
- Damar Ç et al: A Chance fracture and accompanying injuries secondary to seat belt trauma in childhood. Spine J. 16(10):e647-8, 2016
- Khurana B et al: Traumatic thoracolumbar spine injuries: what the spine surgeon wants to know. Radiographics. 33(7):2031-46, 2013
- Pizones J et al: Prospective analysis of magnetic resonance imaging accuracy in diagnosing traumatic injuries of the posterior ligamentous complex of the thoracolumbar spine. Spine (Phila Pa 1976). 38(9):745-51, 2013
- Lenarz CJ et al: Comparative reliability of 3 thoracolumbar fracture classification systems. J Spinal Disord Tech. 22(6):422-7, 2009
- 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
- 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
- Groves CJ et al: Chance-type flexion-distraction injuries in the thoracolumbar spine: MR imaging characteristics. Radiology. 236(2):601-8, 2005
- Hsu JM et al: Thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging. Injury. 34(6):426-33, 2003
- Liu YJ et al: Flexion-distraction injury of the thoracolumbar spine. Injury. 34(12):920-3, 2003
- Sapkas GS et al: Thoracic spinal injuries: operative treatments and neurologic outcomes. Am J Orthop. 32(2):85-8, 2003
- 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
- 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
- Beaunoyer M et al: Abdominal injuries associated with thoraco-lumbar fractures after motor vehicle collision. J Pediatr Surg. 36(5):760-2, 2001
- Greenwald TA et al: Pediatric seatbelt injuries: diagnosis and treatment of lumbar flexion-distraction injuries. Paraplegia. 32(11):743-51, 1994
- Anderson PA et al: Flexion distraction and chance injuries to the thoracolumbar spine. J Orthop Trauma. 5(2):153-60, 1991
- Reid AB et al: Pediatric Chance fractures: association with intra-abdominal injuries and seatbelt use. J Trauma. 30(4):384-91, 1990
- 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
- Chance GQ: Note on a type of flexion fracture of the spine. Br J Radiol. 21(249):452, 1948
