Pediatric Chance Fracture of Lumbar Spine

  • Etiology:
    — Lap belt injury causing hyperflexion without axial loading
    — Unstable flexion-distraction injury of thoracic-lumbar junction
  • Imaging: 3 column fracture of spine – anterior column compression fracure, middle and posterior columns dislocation
  • Imaging MRI: Posterior longitudinal ligament and interspinous ligament injuries with relatively intact anterior longitudinal ligament
  • DDX:
  • Complications:
    — 40% have intraabdominal injuries – laceration or contusion of pancreas or duodenum or jejunum or mesentery
    — Associated with fracture of rib or sternum or clavicle
    — Soft tissue injury to rectus abdominis or peritoneum or diaphragm
    — Aortic injury
  • Treatment:
  • Clinical:
    — Unstable spine fracture

Radiology Cases of Chance Fracture of Lumbar Spine

Radiograph of Chance fracture
AP (left) and lateral (right) radiographs of the lumbar spine show a three column fracture of the L3 vertebral body.
CT of anterior and posterior column fractures of the lumbar spine
Sagittal CT without contrast of the lumbar spine shows a fracture of the anterior and posterior columns of the L1 vertebral body and fractures of the anterior columns of the L2 and L3 vertebral bodies.
CT of Chance fracture of L1 vertebral body
Coronal (above left), sagittal (above right) and axial (below) CT without contrast of the lumbar spine shows a flexion distraction fracture of the L1 vertebral body and its posterior elements and a compression fracture of the L4 vertebral body.