Broken Bones: The X-Ray Atlas of Fractures by Chew Felix S. & Hyojeong Mulcahy & Christin M. Brown

Author:Chew, Felix S. & Hyojeong Mulcahy & Christin M. Brown [Chew, Felix S.]
Language: eng
Format: epub
Publisher: BareBonesBooks.com
Published: 2009-10-05T00:00:00+00:00

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Case 5-28. Chance fracture. Lateral and AP radiographs of the thoracolumbar junction. First described by Chance in 1948, this fracture pattern differs from the flexion distraction injury in that it is mainly a distraction injury [16]. It is a horizontal fracture through the vertebra and posterior elements sustained in MVA with a seatbelt. It has been described as a fulcrum fracture because the seatbelt acts as a fulcrum and absorbs the flexion or compression force and the spine, being posterior to the fulcrum, sustains the tensile forces through all its columns, thereby making it a distraction injury [17]. In a conventional flexion distraction type injury the anterior column of the spine acts as the fulcrum and absorbs the compressive forces that leads to significant wedging which is not typically seen with Chance fractures. Three patterns are seen with this injury. One involves disruption of the posterior ligaments and facet joints and posterior disc. Another involves a horizontal fracture through the posterior elements. The third is a horizontal fracture that dissects through the posterior elements and vertebral body. When a compression deformity occurs it is confined to the anterior superior part of the vertebral body. Associated bowel, pancreas, and mesenteric injury can be seen 15-20% of the time [18].

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