12/2/2023 0 Comments Chance fracture![]() Similarly, Rumball and Jarvis 3 reviewed 10 cases of pediatric “Chance fracture.” Nine of these were treated conservatively. Average progression in the kyphosis angle was 3°. In 1 patient, a paraplegic, a slight kyphosis developed at the fracture site. Six fractures demonstrated satisfactory healing. Only 1 patient required operative treatment for progressive refractory kyphosis. 1 Of the 7 “Chance-type” fractures reported by Reid and colleagues, 16 6 were treated with bedrest and postural reduction followed by application of a body cast. A review of 42 children and adolescents with various spinal fractures noted that the natural history of spinal injury in this population was “characteristically benign” and that late morbidity was not generally seen. Although a few reports have described surgical treatment of these injuries 1, 9 and operative management was recommended for adolescent patients in a recent review article, 17 the majority of reported cases have been managed conservatively with generally good results. The literature on flexion-distraction injuries in children and adolescents is restricted to a few small series and case reports. 9 – 12 Further, the occurrence of “Chance-type” fractures among children and adolescents as well as the characteristics that distinguish them from those of the adults were reported. Subsequent research elucidated various patterns of lumbar flexion-distraction injuries and their pathomechanics. With increased use of lap belts, associated lumbar spinal injuries become more common. In 1968, Smith and Kaufer 9 better defined the relationship between lap belts and spinal injury and postulated tension, created by forced extension about the belt as the mechanism of injury. 7 Later, Howland and associates 8 described a similar “Chance fracture” that exited in the anterior vertebral body and was associated with the use of a lap belt. These were believed to be flexion-type injuries, although the author could not explain why the vertebral body was only slightly wedged anteriorly. In 1948, Chance 7 reported 3 cases of spinal fractures in which the fracture line extended transversely through the spinous process and neural arch to exit in the posterior-superior vertebral end plate. 2), as well as severe central spinal stenosis ( Fig. Computed tomography showed a split in the 元 spinous process and pars inter-articularis ( Fig. The kyphosis angle was 36° and horizontal displacement was 44% as measured by the method of Denis and colleagues 4 and Dupuis and associates, 5 respectively. Radiographs demonstrated anterior wedging of 元 with retrolisthesis of 元 on L4 ( Fig. ![]() She was unsteady while walking and could only travel 15 m before having to rest because of claudicant leg pain. On examination at the time of her current presentation, she had a bilateral high-stepping drop-foot gait. At 2-year follow-up she was stated to be asymptomatic, fully active with no neurologic symptoms and radiographs that were essentially unchanged. This was followed by immobilization for 3 months in extension in a plaster body cast with reported maintenance of the corrected alignment with slight kyphosis at the fracture site on on the radiographs. Radiographs were reported as showing “a compression fracture of the anterior portion of the 元 vertebral body with a horizontal fracture line and separation of the posterior rim of the body and shattering of the pedicles, complete disruption of the lamina of 元 with no connection of the inferior articulation facets and the body.” The documented original diagnosis was that of an “L2–3 Chance fracture.” Treatment consisted of hyperextension on a Stryker frame for 3 weeks with reported good correction of the deformity on the radiograph. At that time she had hypoesthesia in the L4 nerve root distribution in her left leg that gradually resolved during her hospitalization. At 15 years of age, she had sustained a back injury in a motor vehicle collision. A 37-year-old woman complained of back pain radiating into both legs, associated with leg weakness and numbness bilaterally, which had progressed slowly over several years to the point of significant disability and the need for narcotic analgesia.
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