Chance Fracture Clinical Presentation

Updated: Nov 05, 2020
  • Author: J Allan Goodrich, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Presentation

History and Physical Examination

The patient has back pain and, on clinical examination, may have a lap seatbelt abrasion across the abdomen. It is vital to be mindful of the high incidence of associated intra-abdominal injuries, such as liver or spleen lacerations, bowel rupture, or pancreatic injury. Therefore, a thorough examination of the abdomen at the initial evaluation is of the utmost importance.

It is wise to ask for a general surgical consultation at this time to ensure that an occult bowel or other viscus injury is not overlooked. Although neurologic findings are uncommon with this injury, it is nonetheless important to perform a thorough neurologic examination that includes motor, sensory, and reflex evaluation. A rectal and bladder examination should also be performed, including evaluation of the residual urine after the patient has voided. Palpation of the thoracolumbar spine is performed to assess points of maximum tenderness and palpable defects.

Radiographic assessment should begin with anteroposterior (AP) and lateral radiographs of the thoracolumbar spine. A demonstrable fracture line may be detected extending through the spinous process, pedicles, and vertebral body. In general, the diagnosis may be determined on the basis of plain radiographs, but occasionally, computed tomography (CT) scans with frontal and sagittal reconstructions are beneficial.

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Complications

If a Chance fracture goes unrecognized, it may result in progressive kyphosis with ensuing pain and deformity. [19] Associated intra-abdominal injuries can result in increased morbidity and mortality. Ureteropelvic junction disruption associated with Chance fracture has been reported. [20] Chance fracture leading to traumatic hemothorax has been described. [21]

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