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Chance Fracture
Jeffrey S. Ross, MD
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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

                                      1. Khurana B et al: Traumatic thoracolumbar spine injuries: what the spine surgeon wants to know. Radiographics. 33(7):2031-46, 2013
                                      2. 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
                                      3. Lenarz CJ et al: Comparative reliability of 3 thoracolumbar fracture classification systems. J Spinal Disord Tech. 22(6):422-7, 2009
                                      4. 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
                                      5. 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
                                      6. Groves CJ et al: Chance-type flexion-distraction injuries in the thoracolumbar spine: MR imaging characteristics. Radiology. 236(2):601-8, 2005
                                      7. Hsu JM et al: Thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging. Injury. 34(6):426-33, 2003
                                      8. Liu YJ et al: Flexion-distraction injury of the thoracolumbar spine. Injury. 34(12):920-3, 2003
                                      9. Sapkas GS et al: Thoracic spinal injuries: operative treatments and neurologic outcomes. Am J Orthop. 32(2):85-8, 2003
                                      10. 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
                                      11. 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
                                      12. Beaunoyer M et al: Abdominal injuries associated with thoraco-lumbar fractures after motor vehicle collision. J Pediatr Surg. 36(5):760-2, 2001
                                      13. Greenwald TA et al: Pediatric seatbelt injuries: diagnosis and treatment of lumbar flexion-distraction injuries. Paraplegia. 32(11):743-51, 1994
                                      14. Anderson PA et al: Flexion distraction and chance injuries to the thoracolumbar spine. J Orthop Trauma. 5(2):153-60, 1991
                                      15. Reid AB et al: Pediatric Chance fractures: association with intra-abdominal injuries and seatbelt use. J Trauma. 30(4):384-91, 1990
                                      16. 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
                                      17. 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

                                          • 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

                                                                          1. Khurana B et al: Traumatic thoracolumbar spine injuries: what the spine surgeon wants to know. Radiographics. 33(7):2031-46, 2013
                                                                          2. 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
                                                                          3. Lenarz CJ et al: Comparative reliability of 3 thoracolumbar fracture classification systems. J Spinal Disord Tech. 22(6):422-7, 2009
                                                                          4. 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
                                                                          5. 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
                                                                          6. Groves CJ et al: Chance-type flexion-distraction injuries in the thoracolumbar spine: MR imaging characteristics. Radiology. 236(2):601-8, 2005
                                                                          7. Hsu JM et al: Thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging. Injury. 34(6):426-33, 2003
                                                                          8. Liu YJ et al: Flexion-distraction injury of the thoracolumbar spine. Injury. 34(12):920-3, 2003
                                                                          9. Sapkas GS et al: Thoracic spinal injuries: operative treatments and neurologic outcomes. Am J Orthop. 32(2):85-8, 2003
                                                                          10. 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
                                                                          11. 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
                                                                          12. Beaunoyer M et al: Abdominal injuries associated with thoraco-lumbar fractures after motor vehicle collision. J Pediatr Surg. 36(5):760-2, 2001
                                                                          13. Greenwald TA et al: Pediatric seatbelt injuries: diagnosis and treatment of lumbar flexion-distraction injuries. Paraplegia. 32(11):743-51, 1994
                                                                          14. Anderson PA et al: Flexion distraction and chance injuries to the thoracolumbar spine. J Orthop Trauma. 5(2):153-60, 1991
                                                                          15. Reid AB et al: Pediatric Chance fractures: association with intra-abdominal injuries and seatbelt use. J Trauma. 30(4):384-91, 1990
                                                                          16. 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
                                                                          17. Chance GQ: Note on a type of flexion fracture of the spine. Br J Radiol. 21(249):452, 1948