Clinical Challenge: July/August, 2015

The Resolution

Diagnosis: Chance fracture. Chance fractures are typically of the lower thoracic spine, with compression of the anterior vertebral body (black arrow, Figure 2) and transverse fracture of the posterior vertebral elements.

It is caused by a forceful flexion injury and is most commonly associated with old-style lap seat belts in automobiles. Newer seat belts with shoulder restraints have made Chance fractures far less common. Serious intra-abdominal injuries are frequently associated such fractures.Immobilize the patient, begin intravenous fluid resuscitation, and transfer the patient to a local emergency department. Images are courtesy of Core Content in Urgent Care Medicine/Teleradiology Specialists Image Database.