Case: An 18 year old female was the restrained passenger in a motor vehicle crash moving at 65 mph. She complained of traumatic low back pain radiating to her abdomen. What is the most likely mechanism of injury, based on this video of CT images?

Poll Results

Hyperflexion

Explanation

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This is a Chance fracture. First described in 1948 by British radiologist George Quintin Chance, the eponymous fracture is a horizontal spinal fracture through the vertebral body and posterior elements (spinous process, laminae, and pedicles) of the thoraco-lumbar region.1

They are most commonly associated with a hyperflexion mechanism from motor vehicle accidents where the occupant is restrained by a lap belt.2

Though the fracture is quite uncommon, up to 33% of individuals with Chance fractures also have serious intra-abdominal injuries, predominantly hollow viscous injuries. When a patient with a Chance fracture also has an abdominal wall contusion, the risk of intra-abdominal injury rises to 85%.3

Master Clinician Bedside Pearls

Robert L. Rogers, MD, FACEP

Associate Professor of Emergency Medicine

Director, The Teaching Course

Department of Emergency Medicine

University of Maryland

Twitter: @EM_Educator

1. Br J Radiol. 1948;21(249):452. PubMed] CHANCE G. Note on a type of flexion fracture of the spine.. 1948;21(249):452. 2. Eur Spine J. 1994;3(4):184-201. PubMed] Magerl F, Aebi M, Gertzbein S, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries.. 1994;3(4):184-201. 3. Am Surg. 2005;71(5):434-438. PubMed] Tyroch A, McGuire E, McLean S, et al. The association between Chance fractures and intra-abdominal injuries revisited: a multicenter review.. 2005;71(5):434-438.

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