Laboratory Studies

The laboratory workup, in general, is the same as it would be for any trauma patient. It should include a baseline complete blood count (CBC), a urinalysis, and an appropriate chemistry profile as indicated. Because of the high incidence of associated intra-abdominal pathology, close attention should be paid to liver function test (LFT) results.

Imaging Studies

The radiographic workup^[23]initially should include anteroposterior (AP) and lateral views of the thoracolumbar junction. The posterior elements should be observed clearly to identify the fracture line and its propagation. (See the image below.)

$Anterior view of Chance fracture of L2 vertebral b$ Anterior view of Chance fracture of L2 vertebral body. Fracture line follows horizontal plane through L2 vertebral body and transverse processes (arrows).

View Media Gallery

Computed tomography (CT) may be necessary to clearly delineate the entire bony nature of this injury; sagittal and coronal reconstructions are helpful.^[24]

As a rule, magnetic resonance imaging (MRI) is unhelpful, except in individuals with unexplained neurologic deficits, which are uncommon with this injury. The scan may demonstrate a contusion of the conus or compression of the cauda equina, which may correlate with the clinical examination.^[25]

Treatment & Management

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Media Gallery

Chance fracture or modified compression fracture of upper lumbar spine may occur when weight of upper body moves forward (red arrow) while person's waist and upper body are fixed in position by seatbelt or steering wheel of automobile (pink arrows). Consequent fixed-position stress results in fracture.
Anterior view of Chance fracture of L2 vertebral body. Fracture line follows horizontal plane through L2 vertebral body and transverse processes (arrows).
Drawing of Chance fracture of thoracolumbar junction. Defect follows irregular horizontal plane (arrows), which results in disruption of anterior (black dotted line), middle (red dotted line), and posterior columns (blue dotted line).

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Author

J Allan Goodrich, MD Staff Physician, Orthopaedic Spine Surgeon, Doctor's Hospital

J Allan Goodrich, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, North American Spine Society, Society of Lateral Access Surgery

Disclosure: Received income in an amount equal to or greater than $250 from: Globus medical<br/>Intellectual property Globus.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

William O Shaffer, MD Former Orthopedic Spine Surgeon, Northwest Iowa Bone, Joint, and Sports Surgeons

William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, International Society for the Study of the Lumbar Spine, Kentucky Medical Association, Kentucky Orthopaedic Society, North American Spine Society, Southern Medical Association, Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey A Goldstein, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Director of Spine Service, Director of Spine Fellowship, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center

Jeffrey A Goldstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, AOSpine, Cervical Spine Research Society, International Society for the Advancement of Spine Surgery, International Society for the Study of the Lumbar Spine, Lumbar Spine Research Society, North American Spine Society, Scoliosis Research Society, Society of Lateral Access Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Globus, 3Spine<br/>Received income in an amount equal to or greater than $250 from: Globus, Nuvasive, Surgalign, 3Spine.

Additional Contributors

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) Professor, Department of Orthopedic Surgery, University of Texas Medical School at Houston

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chance Fracture Workup

Laboratory Studies

Imaging Studies

References

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