Chance fracture - Revision history

Rossdonaldson1: /* Workup */

2023-10-18T16:04:00Z

Workup

← Older revision		Revision as of 16:04, 18 October 2023
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	===Workup===		===Workup===
	*Obtain sagittally reconstructed CT of T and L spines if suspect lap-belt mechanism or flexion-distraction		*Obtain sagittally-reconstructed CT of thoracic and lumbar spines if suspect lap-belt mechanism or flexion-distraction
	**Evaluate for retropulsion of bony fragments		**Evaluate for retropulsion of bony fragments
	*Obtain MRI to evaluate for ligamentous injuries or spinal cord injuries		*Obtain MRI to evaluate for ligamentous injuries or spinal cord injuries

Patricklin at 20:42, 25 September 2023

2023-09-25T20:42:33Z

← Older revision		Revision as of 20:42, 25 September 2023
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	==Background==		==Background==
	*Unstable		*Unstable spinal fracture
	*Most common at T12-L2 due to spinal curvature and mechanism		**Extends horizontally posterior to anterior through the spinous process, pedicles, vertebral body
	*May be misdiagnosed as anterior compression fracture~~, which is~~ usually stable		*Caused by flexion-distraction forces; ex. seatbelt use in MVC
			**Upon deceleration, the spine forcibly flexes over the seatbelt, distracting (pulling apart) the middle/posterior column of spine
			**Most common at T12-L2 due to spinal curvature and mechanism
			*Incidence of concurrent intra-abdominal hollow viscus injuries is 50%<ref>Koay J, Davis DD, Hogg JP. Chance Fractures. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536926/</ref>
			**Ex. bowel perforations and mesenteric lacerations
			**Intra-abdominal injuries more commonly associated than neuro deficits
			*May be misdiagnosed as anterior compression fracture (usually stable)

	{{Vertebral fractures and dislocations types}}		{{Vertebral fractures and dislocations types}}

	==Clinical Features==		==Clinical Features==
	*~~Common mechanism: seat belt serves as axis of rotation with failure of middle~~ and ~~posterior columns~~		*Back pain and thoracolumbar midline spinal tenderness to palpation
	*Seat Belt Injury: ~~lap belt worn above the pelvic bones without a shoulder harness~~		*Seatbelt sign: ecchymosis across the abdominal wall in the location of a lap belt<ref>Huecker MR, Chapman J. Seat Belt Injury. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470262/</ref>
	*~~Mechanism: minor anterior vertebral compression with failure of the middle and posterior columns~~		*Abdominal pain
	*~~Intra-abdominal injuries more commonly associated than neuro~~ deficits		*Lower extremity neurological deficits

	==Differential Diagnosis==		==Differential Diagnosis==
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	[[File:PchancefracX.png\|thumb\|Chance fracture of T10 and fracture of T9 due to a seatbelt during an MVC on xray.]]		[[File:PchancefracX.png\|thumb\|Chance fracture of T10 and fracture of T9 due to a seatbelt during an MVC on xray.]]
	[[File:PchancefracCT.png\|thumb\|Chance fracture of T10 and fracture of T9 due to a seatbelt during an MVC on CT.]]		[[File:PchancefracCT.png\|thumb\|Chance fracture of T10 and fracture of T9 due to a seatbelt during an MVC on CT.]]

	===Workup===		===Workup===
	*Obtain sagittally reconstructed CT if suspect lap-belt mechanism or flexion-distraction		*Obtain sagittally reconstructed CT of T and L spines if suspect lap-belt mechanism or flexion-distraction
			**Evaluate for retropulsion of bony fragments
			*Obtain MRI to evaluate for ligamentous injuries or spinal cord injuries
			*Obtain CT chest/abdomen/pelvis if suspecting intra-abdominal injuries

	===Diagnosis===		===Diagnosis===
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	**Non-operative immobilization with cast or TLSO		**Non-operative immobilization with cast or TLSO
	*If neurologic deficits present:		*If neurologic deficits present:
	**Surgical decompression and ~~stabilization~~		**Surgical decompression and fixation/fusion

	==Disposition==		==Disposition==
			*Admit

	==See Also==		==See Also==

Elcatracho: /* Management */

2021-02-11T04:12:52Z

Management

← Older revision		Revision as of 04:12, 11 February 2021
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	==Management==		==Management==
			*If no neurologic deficits present:
			**Non-operative immobilization with cast or TLSO
			*If neurologic deficits present:
			**Surgical decompression and stabilization

	==Disposition==		==Disposition==

Rossdonaldson1: /* Differential Diagnosis */

2020-10-24T13:20:48Z

Differential Diagnosis

← Older revision		Revision as of 13:20, 24 October 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
			{{Lower back pain DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Background */

2020-10-24T12:48:52Z

Background

← Older revision		Revision as of 12:48, 24 October 2020
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	*Most common at T12-L2 due to spinal curvature and mechanism		*Most common at T12-L2 due to spinal curvature and mechanism
	*May be misdiagnosed as anterior compression fracture, which is usually stable		*May be misdiagnosed as anterior compression fracture, which is usually stable

			{{Vertebral fractures and dislocations types}}

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* See Also */

2020-10-24T12:48:30Z

Rossdonaldson1: /* Evaluation */

2020-10-24T12:48:10Z

Evaluation

← Older revision		Revision as of 12:48, 24 October 2020
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	==Evaluation==		==Evaluation==
	[[File:PchancefracCT.png\|thumb\|Chance fracture of T10 and fracture of T9 due to a seatbelt during an MVC.]]		[[File:PchancefracX.png\|thumb\|Chance fracture of T10 and fracture of T9 due to a seatbelt during an MVC on xray.]]
			[[File:PchancefracCT.png\|thumb\|Chance fracture of T10 and fracture of T9 due to a seatbelt during an MVC on CT.]]
	===Workup===		===Workup===
	*Obtain sagittally reconstructed CT if suspect lap-belt mechanism or flexion-distraction		*Obtain sagittally reconstructed CT if suspect lap-belt mechanism or flexion-distraction

Rossdonaldson1: /* Evaluation */

2020-10-24T12:46:05Z

Evaluation

← Older revision		Revision as of 12:46, 24 October 2020
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	==Evaluation==		==Evaluation==
			[[File:PchancefracCT.png\|thumb\|Chance fracture of T10 and fracture of T9 due to a seatbelt during an MVC.]]
	===Workup===		===Workup===
	*Obtain sagittally reconstructed CT if suspect lap-belt mechanism or flexion-distraction		*Obtain sagittally reconstructed CT if suspect lap-belt mechanism or flexion-distraction

Rossdonaldson1: /* References */

2020-10-24T12:44:30Z

References

← Older revision		Revision as of 12:44, 24 October 2020
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	==References==		==References==
	<references/>		<references/>

			[[Category:Trauma]]
			[[Category:Neurology]]
			[[Category:Orthopedics]]

Rossdonaldson1 at 12:44, 24 October 2020

2020-10-24T12:44:12Z

@@ Line 1: / Line 1: @@
-====[[Chance fracture]] (Flexion-distraction injuries)====
+==Background==
 *Common mechanism: seat belt serves as axis of rotation with failure of middle and posterior columns
 *Seat Belt Injury: lap belt worn above the pelvic bones without a shoulder harness
 *Mechanism: minor anterior vertebral compression with failure of the middle and posterior columns
 *Intra-abdominal injuries more commonly associated than neuro deficits
 ==Differential Diagnosis==
@@ Line 24: / Line 15: @@
 ==Evaluation==
 ===Workup===
 ===Diagnosis===
 ==Management==

← Older revision		Revision as of 12:48, 24 October 2020
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	==See Also==		==See Also==
			*[[Thoracic and lumbar fractures and dislocations]]

	==External Links==		==External Links==