Review Question - QID 218564

The patient is presenting with a lap seat belt injury which is associated with flexion-distraction injuries (Chance fractures) of the thoracolumbar spine and abdominal injuries.

Flexion-distraction injuries (Chance fractures) of the thoracolumbar spine are often unstable injuries than can involve all three spinal columns as described by Denis. These often occur as a result of lap seat belt injuries where the flexion and distraction mechanism with a point of rotation that is anterior to the spinal column. Abdominal injuries, such as duodenal tears, are commonly associated in up to 50% of cases. Isolated bone injuries can be treated with bracing or temporary instrumentation, whereas ligamentous injuries require posterior spinal fusion.

Reid et al. reported seven cases of pediatric Chance fractures associated with abdominal injuries and seatbelt use. They emphasized the association between the "seatbelt sign" and this injury which is characterized by a lower abdominal ecchymosis.

Rush et al. performed a retrospective review of pediatric trauma registries assessing associated injuries with spinal trauma. They reported patients between 13- to 19 years old were more likely to sustain a spinal injury with thoracic injuries (pneumothorax, rib fractures, and pulmonary contusions) being the most commonly associated injury. They conclude with a recommendation for a careful exam of the entire body in pediatric patients presenting with spinal trauma to assess for associated injuries.

Arkader et al. performed a multicenter retrospective study of 35 pediatric patients with Chance fractures. They reported 43% of patients presented with a neurologic deficit with patients treated surgically having greater initial kyphosis and overall improved outcomes long-term. They concluded surgical treatment results in better outcomes in pediatric patients with Chance fractures.

Daniels et al. reviewed pediatric thoracolumbar spine trauma. They stated these injuries are associated with high-energy trauma with concomitant thoracic or abdominal injuries. They stressed the importance of early diagnosis and management of these injuries due to the impact these injuries can have on patient quality of life.


Incorrect answers
Answer 1: Vertebral compression fractures are typically associated with low-energy falls in geriatric patients with osteoporosis with anterior column involvement only.
Answer 3: Facet fractures are often associated with a rotational mechanism and not often associated with lap seat belt injuries.
Answer 4: Thoracolumbar burst fractures are often associated with axial injury mechanisms, such as a fall from height, with a flexion component leading to anterior and middle column involvement.
Answer 5: Lumbar disc herniations are often the result of lifting heavy loads with a flexed lumbar spine and are not often associated with car seat belt injuries.