- The Chance fracture is a transverse fracture through a vertebral body and neural arch.
- Also known as the seat belt fracture, it occurs at the thoracolumbar junction and is usually associated with motor vehicle accidents in which the injured passenger is wearing a seat belt
- “When flexion of the spine exceeds normal limits something has to give way.” GQ Chance.
- The original description of this injury (1948) was a purely osseous injury.
- Termed a seat-belt injury, this in jury occurs when there is flexion of the spine with the fulcrum of the force in the anterior abdominal wall, such as when one abruptly stops a vehicle with a lap-belt in place. This causes distraction of the posterior and middle, and possibly anterior, columns of the spine, creating an unstable injury.
- A true Chance fracture consists of a horizontal splitting of the posterior elements and vertebral body; purely ligamentous and disc, and mixed soft tissue and osseous versions are now commonly lumped under the name Chance fracture.
- These injuries typically occur at the thoracolumbar junction or in the upper lumbar spine. When the anterior ligaments are also injured, this injury may be a fracture-dislocation, carrying a higher incidence of neurological injury. With these fractures, one must always be alert to the high likelihood of injury to the bowel and other abdominal viscera.
- The term “Chance’s fracture” was reportedly first used by Nicoll in 1949
- Chance GQ. Note on a type of flexion fracture of the spine. Br J Radiol. 1948 Sep;21(249):452. [PMID 18878306]
- Bernstein MP, Mirvis SE, Shanmuganathan K. Chance-type fractures of the thoracolumbar spine: imaging analysis in 53 patients. AJR Am J Roentgenol. 2006 Oct;187(4):859-68. [PMID 16985126]
- Nicoll EA. Fractures of the dorso-lumbar spine. J Bone Joint Surg Br. 1949 Aug;31B(3):376-94. [PMID 18148776]
- Hunter TB, Peltier LF, Lund PJ. Radiologic History Exhibit Musculoskeletal Eponyms: Who Are Those Guys? Radiographics. 2000 May-Jun;20(3):819-36.[Full text]
- Aebi M. Classification of thoracolumbar fractures and dislocations. Eur Spine J. 2010;19 Suppl 1 : S2-7.[PMC2899723]
LITFL Related Links
- Biographical Medical Eponyms – A-Z of eponymous medical pioneers
- Eponymictionary – Searchable Eponymictionary Database
- Medical Eponyms – A-Z of signs, syndromes, diseases and classifications
- Orthopaedic Eponyms – Eponymous orthopedic fractures and classifications
- Cardiac Eponyms – Eponymous cardiology collection