summary Chance fractures are traumatic fractures of the thoracic and lumbar spine that occur via a flexion-distraction injury mechanism and are associated with high rates of mechanical instability and gastrointestinal injuries Diagnosis of bony Chance fractures is made with radiographs or CT scan. An MRI may be necessary to identify a ligamentous Chance injury involving disruption of the PLC Treatment can be nonoperative or involve surgical spinal stabilization, depending on the presence of mechanical instability and/or neurologic deficits Etiology Mechanism a flexion-distraction injury (seatbelt injury) may be a bony injury may be a ligamentous injury (flexion-distraction injury) login to view 1 more bullet middle and posterior columns fail under tension anterior column fails under compression Associated injuries high rate of gastrointestinal injuries (50%) Imaging Radiographs AP and lateral flexion-extension radiographs CT evaluate the degree of bone injury and retropulsion of posterior wall into canal MRI evaluate for injury to the posterior elements Treatment Nonoperative immobilization in cast or TLSO indications login to view 3 more bullets technique login to view 2 more bullets Operative surgical decompression and stabilization indications login to view 2 more bullets techniques login to view 7 more bullets Complications Pain most common Deformity scoliosis progressive kyphosis common with unrecognized injury of the PLL flat back deformity leads to pain, a forward flexed posture, and easy fatigue posttraumatic syringomyelia Nonunion