Chance fracture

chance fracture of spine

1. CHANCE FRACTURE DR PRATIK DHABALIA RESIDENT IN ORTHOPEDICS Dr DY Patil Hospital , Navi Mumbai

2. INTRODUCTION AKA FLEXION-DISTRACTION INJURY AKA SEATBELT INJURY

3. MECHANISM They tend to occur from a flexion injury of the vertebral body and distraction type injury of the posterior elements Typically the flexion fulcrum occurs anterior to the abdomen The anterior and middle columns fail in compression, and the posterior column fails in distraction

4. LOCATION This fracture most commonly occurs about the upper lumbar spine (with the thoracolumbar junction accounting for ~50% of cases)

5. ASSOCIATED INJURIES There is a high incidence of associated intra-abdominal injuries (especially the  pancreas  and  duodenum ) that can result in increased morbidity and mortality. Associated intra-abdominal injuries appear to be more common in the paediatric age group If unrecognised, Chance injuries may result in progressive kyphosis with resulting pain and deformity.

6. Xrays Anterior wedge fracture of the vertebral body with a horizontal fracture through posterior elements or distraction of facet joints and spinous processes. empty vertebral body sign : can be seen on an AP radiograph and results from the vertical separation of the posterior elements displacing the spinous processes or spinous process fracture fragments off the vertebral body on the AP projection transverse fractures across the transverse processes, laminae, and articular processes widening of the interpedicular distance : often suggests a burst component widening of the facet joints and increased intercostal spacing widening of the interspinous spaces

7. CT more accurately delineates fracture details MRI useful to assess for ligamentous injury and cord injury 

8. Management Nonoperative: neurologically intact patient stable injury patterns with intact posterior elements immobilization in cast or TLSO must be followed for non-union and kyphotic deformity 

9. Operative: patients with neurologic deficit unstable spine with injury to the posterior ligaments (soft-tissue Chance fx ) surgical decompression and stabilization

10. - Anterior decompression and stabilization usually with vertebrectomy and strut grafting followed by instrumentation Posterior indirect decompression and stabilization and compression fusion construct one level above and one level below