A Chance fracture is a type of

vertebral fracture A spinal fracture, also called a vertebral fracture or a broken back, is a fracture affecting the vertebrae of the spinal column. Most types of spinal fracture confer a significant risk of spinal cord injury. After the immediate trauma, there is ...

that results from excessive

flexion Motion, the process of movement, is described using specific anatomical terminology, anatomical terms. Motion includes movement of Organ (anatomy), organs, joints, Limb (anatomy), limbs, and specific sections of the body. The terminology used de ...

of the

spine Spine or spinal may refer to: Science Biology * Spinal column, also known as the backbone * Dendritic spine, a small membranous protrusion from a neuron's dendrite * Thorns, spines, and prickles, needle-like structures in plants * Spine (zoology), ...

. Symptoms may include abdominal bruising (

seat belt sign Seat belt syndrome is a collective term that includes all injury profiles associated with the use of seat belts. It is defined classically as a ''seat belt sign'' (seat belt marks on the body) plus an intra-abdominal organ injury (e.g. bowel perfo ...

), or less commonly paralysis of the legs. In around half of cases there is an associated abdominal injury such as a

splenic rupture A splenic injury, which includes a ruptured spleen, is any injury to the spleen. The rupture of a normal spleen can be caused by trauma, such as a traffic collision. Signs and symptoms In minor injuries with little bleeding, there may be abdomi ...

small bowel The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of nutrients from food takes place. It lies between the stomach and large intestine, and receives bile and pancreatic juice through the p ...

injury,

pancreatic The pancreas (plural pancreases, or pancreata) is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine ...

injury, or

mesenteric In human anatomy, the mesentery is an organ that attaches the intestines to the posterior abdominal wall, consisting of a double fold of the peritoneum. It helps (among other functions) in storing fat and allowing blood vessels, lymphatics, and ...

tear. Injury to the bowel may not be apparent on the first day. The cause is classically a head-on motor vehicle collision in which the affected person is wearing only a lap belt. Being hit in the abdomen with an object like a tree or a fall may also result in this fracture pattern. It often involves disruption of all three columns of the

vertebral body Each vertebra (: vertebrae) is an irregular bone with a complex structure composed of bone and some hyaline cartilage, that make up the vertebral column or spine, of vertebrates. The proportions of the vertebrae differ according to their spinal ...

(anterior, middle, and posterior). The most common area affected is the lower

thoracic The thorax (: thoraces or thoraxes) or chest is a part of the anatomy of mammals and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main ...

and upper

lumbar spine The lumbar vertebrae are located between the thoracic vertebrae and pelvis. They form the lower part of the back in humans, and the tail end of the back in quadrupeds. In humans, there are five lumbar vertebrae. The term is used to describe t ...

. A

CT scan A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

is recommended as part of the diagnostic work-up to detect any potential abdominal injuries. The fracture is often

unstable In dynamical systems instability means that some of the outputs or internal state (controls), states increase with time, without bounds. Not all systems that are not Stability theory, stable are unstable; systems can also be marginal stability ...

. Treatment may be

conservative Conservatism is a cultural, social, and political philosophy and ideology that seeks to promote and preserve traditional institutions, customs, and values. The central tenets of conservatism may vary in relation to the culture and civiliza ...

with the use of a brace or via surgery. The fracture is currently rare. It was first described by G. Q. Chance, a radiologist from

Manchester, UK Manchester () is a city and the metropolitan borough of Greater Manchester, England. It had an estimated population of in . Greater Manchester is the third-most populous metropolitan area in the United Kingdom, with a population of 2.92&nbs ...

, in 1948. The fracture was more common in the 1950s and 1960s before shoulder harnesses became common.

Mechanism

In some Chance fractures there is a transverse break through the bony

spinous process Each vertebra (: vertebrae) is an irregular bone with a complex structure composed of bone and some hyaline cartilage, that make up the vertebral column or spine, of vertebrates. The proportions of the vertebrae differ according to their spina ...

while in others there is a tear of the

supraspinous ligament The supraspinous ligament (also known as the supraspinal ligament) is a ligament extending across the tips of the spinous processes of the vertebra of the vertebral column. Anatomy The supraspinous ligament connects the tips of the spinous proces ...

ligamentum flavum The ligamenta flava (: ligamentum flavum, Latin for ''yellow ligament'') are a series of ligaments that connect the ventral parts of the laminae of adjacent vertebrae. They help to preserve upright posture, preventing hyperflexion, and ensuring ...

interspinous ligament The interspinous ligaments (interspinal ligaments) are thin, membranous ligaments that connect adjoining spinous processes of the vertebra in the spine. They take the form of relatively weak sheets of fibrous tissue and are well developed only in ...

, and

posterior longitudinal ligament The posterior longitudinal ligament is a ligament connecting the posterior surfaces of the vertebral bodies of all of the vertebrae of humans. It weakly prevents hyperflexion of the vertebral column. It also prevents posterior spinal disc hernia ...

Diagnosis

$PchancefracX$ On plain X-ray, a Chance fracture may be suspected if two spinous processes are excessively far apart. A

of the chest, abdomen, and pelvis is recommended as part of the diagnostic work-up to detect any potential abdominal injuries. MRI may also be useful. The fracture is often

History

It was first described by G. Q. Chance, an Irish radiologist in

, in 1948. The fracture was more common in the 1950s and 1960s before shoulder harnesses became common.

References

External links

{{Fractures Bone fractures Wikipedia medicine articles ready to translate