Updated: 10/5/2016

Chance Fracture (flexion-distraction injury)

Topic
Review Topic
0
0
Questions
3
0
0
Evidence
6
0
0
Cases
1
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
 

Please rate topic.

Average 3.4 of 46 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
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%

(2477/3251)

2

Torsion

2%

(51/3251)

3

Fatigue

0%

(11/3251)

4

Compression

18%

(598/3251)

5

Shear

3%

(103/3251)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 1
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
ARTICLES (9)
CASES (1)
Topic COMMENTS (9)
Private Note