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Spine
Published in Pankaj Sharma, Nicola Maffulli, Practice Questions in Trauma and Orthopaedics for the FRCS, 2017
Pankaj Sharma, Nicola Maffulli
A Chance fracture is a pure bony injury extending from posterior to anterior, through the spinous process, pedicles and vertebral body. The typical history is of a rear-seat passenger wearing a lap seat belt, involved in a road traffic accident. In general, Chance fractures can be managed by immobilisation in a thoracolumbosacral orthosis (TLSO) or hyperextension cast. Surgical indications include the polytraumatised patient, significant displacement, or patients whose size makes closed treatment difficult or impractical.
Injuries of the spine
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
The Chance fracture (being an ‘all-bone’ injury) heals rapidly and can be managed conservatively with bed rest and bracing. Posterior fixation is cost-effective and allows early mobilization. Ligamentous Chance injuries will not stabilize and need posterior instrumented fusion (Figure 28.32).
Trauma
Published in Harry Griffiths, Musculoskeletal Radiology, 2008
George Q. Chance (14) wrote a wonderful two-page paper in 1948 titled “Note on a Type of Flexion Fracture of the Spine,” published in the British Journal of Radiology. He described a true flexion fracture with horizontal splitting of the vertebral body and the neural arch, and he reported on three cases with little anterior wedging and no dislocation of the facet joints. None of his three patients had cord damage. The mechanism of injury was hyperextension of the spine. Denis had 19 cases of seat belt injuries, four involving T12, four at L1, six at L2, and five at L3. By definition, a Chance fracture is a horizontal fracture through the vertebral body, usually adjacent to the upper end plate, although it may, in fact, involve the disc, or both the disc and the body (Figs. 132A, B and 133A, B).
Management of cervical fractures in ankylosing spondylitis patients: immediate fixation effort via vertebroplasty with one-staged combined anterior and posterior fixation
Published in British Journal of Neurosurgery, 2023
Ming-Fai Tse, Yi-Hsin Tsai, Lin-Hsue Yang, Fu-Shan Jaw, Che-Kuang Lin
A 60-year-old man with a history of ankylosing spondylitis without regular treatment was assaulted by his son and hit his forehead on a wall. He complained of severe neck pain with mild right hand numbness and clumsiness after the injury and visited our emergency department. Neurological examination revealed no obvious focal weakness, and deep tendon reflexes were 2+ for all limbs. Cervical spine CT showed a C7 Chance fracture running through the vertebral body and bilateral pedicle to the spinous process (Figure 2(A)). MRI showed no cord injury (Figure 2(B)). Fixation surgery was suggested and vertebroplasty at the C7 level was performed during one-staged combined anterior and posterior fixation. Intra-operative fluoroscopy results are shown in Figure 2(C & D). The patient tolerated the procedure well, and pain relief was achieved just after surgery (Visual analogue scle (VAS) improved from 8 to 2). The patient complied poorly with collar use (SOMI brace) but post-operative radiographs did not reveal implant failure. There were no major post-operative complications in the first 8 months of follow-up. Plain radiographs also revealed complete fusion of the fractured C7 (Figure 2(E)). The pre-operative Frankel’s scale and ASIA scale were E and the post-operative Frankel’s scale and ASIA scale remained E.
Thoracolumbar fracture classification: evolution, merits, demerits, updates, and concept of stability
Published in British Journal of Neurosurgery, 2021
Hanuman Prasad Prajapati, Raj Kumar
McAfee studied the computed tomography (CT) scans of 100 thoracolumbar fractures and develop a simpler classification based on the mechanism of injury and its morphology. They divided thoracolumbar fractures into 6 categories: wedge compression fracture, stable burst fracture, unstable burst fracture, Chance fracture, flexion-distraction injury, and translational injury. However, this classification system has not been widely used because its reliability and validity are not yet verified.10