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CASE REPORT Table of Contents   
Year : 2005  |  Volume : 39  |  Issue : 2  |  Page : 123-124
Unusual mechanism of chance fracture in an adult - A case report


Southampton General Hospital, Southampton, United Kingdom

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How to cite this article:
Todkar M, Senbaga N R. Unusual mechanism of chance fracture in an adult - A case report. Indian J Orthop 2005;39:123-4

How to cite this URL:
Todkar M, Senbaga N R. Unusual mechanism of chance fracture in an adult - A case report. Indian J Orthop [serial online] 2005 [cited 2019 Oct 15];39:123-4. Available from: http://www.ijoonline.com/text.asp?2005/39/2/123/36790

   Introduction Top


Transverse fractures of vertebral arch or Chance fractures are associated with lap-type seat belt use. In 1948, Chance [1] first described a transverse fracture of the vertebral arch produced by a hyper flexion injury of the spine. Since that time, the Chance fracture is noted to be an unusual lesion in adults, very rarely described in the paediatric patient [2] . The fracture is most frequently associated with injuries sustained while wearing lap-type seat belts [3],[4],[5] . This case reports a 30 year-old male who sustained lumbar Chance fracture as a result of fall from height with sudden severe hyperflexion of lumbar spine.


   Case Report Top


A thirty year-old male fell from a height of 20 feet. He sustained close fracture of both calcanei, open fracture of left tibia and complained of pain in lumbar area. Palpation revealed tenderness in lumbar region. His neurological examination was normal. Radiographs and CT scan revealed a transverse fracture of L 2 , demonstrating split posterior elements and progressing anteriorly into body of vertebra [Figure - 1],[Figure - 2]. For this fracture, L1-L3 fusion was carried out using metal cage and posterior instrumentation was done using pedicular screws [Figure - 3]. External fixator was applied for open fracture of tibia and fracture calcaneum was fixed internally on one side and other treated conservatively.


   Discussion Top


The Chance fracture consists of a horizontal splitting of the spine and the neural arch of vertebra, ending in an upward curve which usually reaches upper surface of the vertebral body and no lateral displacement or rotation of the fracture fragments [1],[4] . The fracture has been reported in children to involve first, second, third and fourth lumbar vertebrae [2],[6],[7] .

The mechanism of injury is hyper flexion of spine over a fulcrum. Howland et al [6] and Hubbard [4] described Chance-type fracture of lumbar vertebra produced by lap-type seat belt acting as a fulcrum across the spine at the time of injury. Smith and Kaufer [5] reported a series of 20 patients with transverse fractures of lumbar spine following injury while wearing lap-type seat belts. They hypothesised that mechanism of injury is one of sudden deceleration, such as occurs with automobile crash or fall. With hyper flexion of the spine over a fulcrum such as a seat belt, the force is displaced anteriorly and lies at point of contact between fulcrum and the abdominal wall. This subjects all of the components of spine to tension stress. The result is a disruption of the ligaments of posterior elements of spine or a transverse fracture of posterior elements. The same type of injury may occur in a fall when the anterior abdominal wall comes in contact with some object such as a tree limb or fence, which acts as a fulcrum and forces the body into acute flexion [4] .

Production of a Chance fracture in a fall over an object acting as a fulcrum has been theorized but not commonly reported in adults or children [5] . Our patient in the report fell from height of 20 feet. There was no history of an object acting as a fulcrum involved in the fall. The mechanism of injury appears to have been that acute flexion of the spine occurred on impact with the ground and the fracture was a failure of the bone in tension.

The recognition of Chance fracture is dependent on high index of suspicion when the history of injury and clinical examination are suggestive of hyper flexion injury of spine. Lateral radiographs of the spine will confirm the diagnosis. Treatment of the Chance fracture involves fusion for the spines considered unstable and immobilization for stable injuries. Our patient did well after fusion of the spine.

 
   References Top

1.Chance GQ. Note on a type of flexion fracture of the spine. Br J Radiol.1948; 21: a452-a453.  Back to cited text no. 1    
2.Blasier RD, LaMont RL. Chance fracture in a child: A case report with nonoperative treatment. J Paediatr Orthop. 1985;5;92.  Back to cited text no. 2    
3.Rogers LF. The roentgenographic appearance of transverse or Chance fracture of spine: The seat belt fracture. Am J Roentgenol Nucl Med. 1971;111:844-889.  Back to cited text no. 3    
4.Horal J, Nachemson A, Scheller S. Clinical and radiological long term follow-up of vertebral fractures in children. Acta Orthop Scand. 1972; 43:491- 503.  Back to cited text no. 4    
5.Smith WS, Kaufer H. Patterns and mechanism of lumbar injuries asso­ciated with lap-seat belts. J Bone Joint Surg (Am). 1969;51:239-254.  Back to cited text no. 5    
6.Howland WJ, Curry JL, Buffington CB. Fulcrum fractures of the lumbar spine. J Am Med Assoc. 1965;193:140.  Back to cited text no. 6    
7.Hubard DD. Injuries of spine in children and adolescents. Clin Orthop. 1974; 100: 56-65.  Back to cited text no. 7    

Top
Correspondence Address:
Manoj Todkar
11, Tuckfield House, Residential Village, Bovemoors Lane, Exeter, EX2 5DS, England
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.36790

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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]



 

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    Introduction
    Case Report
    Discussion
    References
    Article Figures
 

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