Chance fracture | |
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Other names | Chance fracture of the spine, [1] flexion distraction fracture, [2] lap seat belt fracture [3] |
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A Chance fracture of T10 and fracture of T9 due to a seatbelt during an MVC. | |
Specialty | Emergency medicine ![]() |
Symptoms | Abdominal bruising, paralysis of the legs [4] |
Complications | Splenic rupture, small bowel injury, mesenteric tear [3] [5] |
Risk factors | Head-on motor vehicle collision in which a person is only wearing a lap belt [2] |
Diagnostic method | Medical imaging (X-ray, CT scan) [1] |
Differential diagnosis | Compression fracture, burst fracture [6] |
Treatment | Bracing, surgery [1] |
Frequency | Rare [7] |
A Chance fracture is a type of vertebral fracture that results from excessive flexion of the spine. [8] [9] Symptoms may include abdominal bruising (seat belt sign), or less commonly paralysis of the legs. [4] [10] In around half of cases there is an associated abdominal injury such as a splenic rupture, small bowel injury, pancreatic injury, or mesenteric tear. [3] [5] Injury to the bowel may not be apparent on the first day. [11]
The cause is classically a head-on motor vehicle collision in which the affected person is wearing only a lap belt. [2] Being hit in the abdomen with an object like a tree or a fall may also result in this fracture pattern. [12] [10] It often involves disruption of all three columns of the vertebral body (anterior, middle, and posterior). [7] [6] The most common area affected is the lower thoracic and upper lumbar spine. [6] A CT scan is recommended as part of the diagnostic work-up to detect any potential abdominal injuries. [5] The fracture is often unstable. [1]
Treatment may be conservative with the use of a brace or via surgery. [1] The fracture is currently rare. [7] It was first described by G. Q. Chance, a radiologist from Manchester, UK, in 1948. [3] [13] The fracture was more common in the 1950s and 1960s before shoulder harnesses became common. [3] [5]
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. [10]
On plain X-ray, a Chance fracture may be suspected if two spinous processes are excessively far apart. [10]
A CT scan of the chest, abdomen, and pelvis is recommended as part of the diagnostic work-up to detect any potential abdominal injuries. [5] [10] MRI may also be useful. [10] The fracture is often unstable. [1]
It was first described by G. Q. Chance, an Irish radiologist in Manchester, UK, in 1948. [3] [13] The fracture was more common in the 1950s and 1960s before shoulder harnesses became common. [3] [5]
A laminectomy is a surgical procedure that removes a portion of a vertebra called the lamina, which is the roof of the spinal canal. It is a major spine operation with residual scar tissue and may result in postlaminectomy syndrome. Depending on the problem, more conservative treatments may be viable.
Lordosis is historically defined as an abnormal inward curvature of the lumbar spine. However, the terms lordosis and lordotic are also used to refer to the normal inward curvature of the lumbar and cervical regions of the human spine. Similarly, kyphosis historically refers to abnormal convex curvature of the spine. The normal outward (convex) curvature in the thoracic and sacral regions is also termed kyphosis or kyphotic. The term comes from the Greek lordōsis, from lordos.
In tetrapods, cervical vertebrae are the vertebrae of the neck, immediately below the skull. Truncal vertebrae lie caudal of cervical vertebrae. In sauropsid species, the cervical vertebrae bear cervical ribs. In lizards and saurischian dinosaurs, the cervical ribs are large; in birds, they are small and completely fused to the vertebrae. The vertebral transverse processes of mammals are homologous to the cervical ribs of other amniotes. Most mammals have seven cervical vertebrae, with the only three known exceptions being the manatee with six, the two-toed sloth with five or six, and the three-toed sloth with nine.
Spondylolisthesis is the displacement of one spinal vertebra compared to another. While some medical dictionaries define spondylolisthesis specifically as the forward or anterior displacement of a vertebra over the vertebra inferior to it, it is often defined in medical textbooks as displacement in any direction. Spondylolisthesis is graded based upon the degree of slippage of one vertebral body relative to the subsequent adjacent vertebral body. Spondylolisthesis is classified as one of the six major etiologies: degenerative, traumatic, dysplastic, isthmic, pathologic, or post-surgical. Spondylolisthesis most commonly occurs in the lumbar spine, primarily at the L5-S1 level with the L5 vertebral body anteriorly translating over the S1 vertebral body.
Spinal fusion, also called spondylodesis or spondylosyndesis, is a neurosurgical or orthopedic surgical technique that joins two or more vertebrae. This procedure can be performed at any level in the spine and prevents any movement between the fused vertebrae. There are many types of spinal fusion and each technique involves using bone grafting—either from the patient (autograft), donor (allograft), or artificial bone substitutes—to help the bones heal together. Additional hardware is often used to hold the bones in place while the graft fuses the two vertebrae together. The placement of hardware can be guided by fluoroscopy, navigation systems, or robotics.
A burst fracture is a type of traumatic spinal injury in which a vertebra breaks from a high-energy axial load, with shards of vertebra penetrating surrounding tissues and sometimes the spinal canal. The burst fracture is categorized by the "severity of the deformity, the severity of (spinal) canal compromise, the degree of loss of vertebral body height, and the degree of neurologic deficit." Burst fractures are considered more severe than compression fractures because long-term neurological damage can follow. The neurologic deficits can reach their full extent immediately, or can progress for a prolonged time.
The erector spinae or spinal erectors is a set of muscles that straighten and rotate the back. The spinal erectors work together with the glutes to maintain stable posture standing or sitting.
Spondylolysis is a defect or stress fracture in the pars interarticularis of the vertebral arch. The vast majority of cases occur in the lower lumbar vertebrae (L5), but spondylolysis may also occur in the cervical vertebrae.
A compression fracture is a collapse of a vertebra. It may be due to trauma or due to a weakening of the vertebra. This weakening is seen in patients with osteoporosis or osteogenesis imperfecta, lytic lesions from metastatic or primary tumors, or infection. In healthy patients, it is most often seen in individuals suffering extreme vertical shocks, such as ejecting from an ejection seat. Seen in lateral views in plain x-ray films, compression fractures of the spine characteristically appear as wedge deformities, with greater loss of height anteriorly than posteriorly and intact pedicles in the anteroposterior view.
The back describes the area of horse anatomy where the saddle goes, and in popular usage extends to include the loin or lumbar region behind the thoracic vertebrae that also is crucial to a horse's weight-carrying ability. These two sections of the vertebral column beginning at the withers, the start of the thoracic vertebrae, and extend to the last lumbar vertebra. Because horses are ridden by humans, the strength and structure of the horse's back is critical to the animal's usefulness.
A laminotomy is an orthopaedic neurosurgical procedure that removes part of the lamina of a vertebral arch in order to relieve pressure in the vertebral canal. A laminotomy is less invasive than conventional vertebral column surgery techniques, such as laminectomy because it leaves more ligaments and muscles attached to the vertebral column intact and it requires removing less bone from the vertebra. As a result, laminotomies typically have a faster recovery time and result in fewer postoperative complications. Nevertheless, possible risks can occur during or after the procedure like infection, hematomas, and dural tears. Laminotomies are commonly performed as treatment for lumbar spinal stenosis and herniated disks. MRI and CT scans are often used pre- and post surgery to determine if the procedure was successful.
A sternal fracture is a fracture of the sternum, located in the center of the chest. The injury, which occurs in 5–8% of people who experience significant blunt chest trauma, may occur in vehicle accidents, when the still-moving chest strikes a steering wheel or dashboard or is injured by a seatbelt. Cardiopulmonary resuscitation (CPR), has also been known to cause thoracic injury, including sternum and rib fractures. Sternal fractures may also occur as a pathological fracture, in people who have weakened bone in their sternum, due to another disease process. Sternal fracture can interfere with breathing by making it more painful; however, its primary significance is that it can indicate the presence of serious associated internal injuries, especially to the heart and lungs.
A Smith fracture is a named vertebral fracture occurring most commonly in the lumbar spine. It is similar to that of a Chance fracture and is associated with seat belt injuries. This fracture represents a fracture through the posterior elements including the superior articular processes but not the spinous process, as well as an avulsion fracture of the vertebral body. It is not to be confused with the more commonly referred to Smith's fracture of the wrist.
A spinal fracture, also called a vertebral fracture or a broken back, is a fracture affecting the vertebrae of the spinal column. Most types of spinal fracture confer a significant risk of spinal cord injury. After the immediate trauma, there is a risk of spinal cord injury if the fracture is unstable, that is, likely to change alignment without internal or external fixation.
Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with leaning forward. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.
The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord found in all chordates has been replaced by a segmented series of bone: vertebrae separated by intervertebral discs. Individual vertebrae are named according to their region and position, and can be used as anatomical landmarks in order to guide procedures such as lumbar punctures. The vertebral column houses the spinal canal, a cavity that encloses and protects the spinal cord.
Passive physiological intervertebral movements (PPIVM) refers to a spinal physical therapy assessment and treatment technique developed by Geoff Maitland used to assess intervertebral movement at a single joint, and to mobilise neck stiffness.
The spinal column, characteristic of each vertebrate species, is a moderately flexible series of vertebrae, each constituting a characteristic irregular bone whose complex structure is composed primarily of bone, and secondarily of hyaline cartilage. They show variation in the proportion contributed by these two tissue types; such variations correlate on one hand with the cerebral/caudal rank, and on the other with phylogenetic differences among the vertebrate taxa.
Seat belt syndrome is a collective term that includes all injury profiles associated with the use of seat belts. It is defined classically as a seat belt sign plus an intra-abdominal organ injury and/or thoraco-lumbar vertebral fractures. The seat-belt sign was originally described by Garrett and Braunstein in 1962 as linear ecchymosis of the abdominal wall following a motor vehicle accident. It is indicative of an internal injury in as many as 30% of cases seen in the emergency department. Disruption of the abdominal wall musculature can also occur but is relatively uncommon.
George Quentin Chance was an Irish radiologist. His note of 1948 titled "Note on a Type of Flexion Fracture of the Spine", published in the British Journal of Radiology described three cases of fractures across the vertebra and neural arch, the 'Chance fracture'.