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https://upload.orthobullets.com/topic/2023/images/lateral xray_moved.jpg
https://upload.orthobullets.com/topic/2023/images/chance_fx_moved.jpg
https://upload.orthobullets.com/topic/2023/images/AP xray_moved.jpg
Introduction
  • Mechanism
    • a flexion-distraction injury (seatbelt injury)
      • may be a bony injury
      • may be ligamentous injury (flexion-distraction injury)
        • more difficult to heal
      • middle and posterior columns fail under tension 
      • anterior column fails under compression 
  • Associated injuries 
    • high rate of gastrointestinal injuries (50%)
Imaging
  • Radiographs
    • obtain AP and lateral   
    • flexion-extension radiographs
  • MRI
    • important to evaluate for injury to the posterior elements
  • CT
    • important to evaluate degree of bone injury and retropulsion of posterior wall into canal
Treatment
  • Nonoperative
    • immobilization in cast or TLSO
      • indications
        • neurologically intact patients with
          • stable injury patterns with intact posterior elements
          • bony Chance fracture
      • technique
        • may cast or brace (TLSO) in extension
        • must be followed for non-union and kyphotic deformity
  • Operative
    • surgical decompression and stabilization
      • indications
        • patients with neurologic deficits
        • unstable spine with injury to the posterior ligaments (soft-tissue Chance fx)
      • techniques
        • anterior decompression and stabilization
          • usually with vertebrectomy and strut grafting followed by instrumentation
        • posterior indirect decompression and stabilization and compression fusion construct
          • historically three levels above and two levels below
          • modern pedicle screws have changed this to one level above and one level below
          • distraction construct in burst fractures
          • compression construct in Chance fractures
Complications
  • Pain
    • most common
  • Deformity
    • scoliosis
    • progressive kyphosis
      • common with unrecognized injury to PLL
    • flat back
      • leads to pain, a forward flexed posture, and easy fatigue
    • post-traumatic syringomyelia
  • Nonunion
 

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Questions (3)

(OBQ07.253) 32-year-old male presents to the emergency department following a motor vehicle accident. A radiograph is shown in Figure A, and a sagittal and axial CT scan are shown in Figure B and C respectively. What is the most likely mode of failure of the posterior spinal column? Review Topic

QID: 914
FIGURES:
1

Tension

76%

(2239/2953)

2

Torsion

2%

(45/2953)

3

Fatigue

0%

(11/2953)

4

Compression

19%

(553/2953)

5

Shear

3%

(94/2953)

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