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Chance Fracture
Chance fracture is an unusual but common cause of abdominal pain following road traffic accidents or horse back riding accidents.
This fracture first described by G. Q Chance in 1948, is a horizontal fracture through the spinous process and posterior structures of the vertebrae. It is a flexion distraction flexion.
It is thus also called transverse spine fracture.
Chance fracture typically occurs following the use of lap only seat belt in a head-on collision road traffic accident. The force of impact throws the weight of the body forward, bending over the seat belt, which acts a fulcrum for the spine to bend and twist forward. Any vertebra from T12 to L4 can be affected, with L2 having the highest incidence of fracture. In up to 78 % of patients in one study who had this type of injury, there were associated intestinal injuries. It is a very unstable injury.
Chance fracture should be suspected in patient with a seat belt injury (seat belt mark on the body) following a vehicular accident plus or minus abdominal pain.
Also, any patient coming in with a history of back and abdominal pain following a fall from a horse back needs to be investigated for possible chance fracture.
An unusual cause of this type of fracture was described in the literatures recently following a fall from a height of about 20 feet. Because of the high incidence of intra-abdominal injuries, suspected cases should be thoroughly examined for intra-abdominal bleed. These abdominal injuries include ruptured spleen, liver, or bowel.
Diagnosis may be difficult in some individuals.
A good history coupled with demonstrable radiological signs will confirm this injury where it exists.
A thoraco-lumbar spine X-ray will show a horizontal line on the body of the vertebra involved. The spinous process may be involved too.
Sometimes, it is only ligamentous injury, and nothing may be visible on X-ray.
A CT –scan may give more details where doubt exist. CT reconstruction images are very useful, but where a facility exists, an MRI may give more details especially where the spinal cord is involved.
For bony injuries, immobilization and rest may be all that is needed, as healing occurs in the bone. They are given hyper-extension orthosis, which are fixed in the opposite direction to the direction of injury. This can be left for 2 weeks at the first instance and re-evaluated.
For patients wit ligamentous injury, or where obesity is an issue, operative treatment is recommended.
Hunching (Kyphosis) of the back is a recognised complication of chance fracture, even after non-operative treatment.
Picture of Chance fracture
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