 | Viet Tran A 49yo male was in the middle rear seat of a car when it was rear ended at moderate speed. He presents with the dreaded back pain... |
He hasn't mobilised since the crash & on palpation has diffuse tenderness down is lower T & upper L-spine both midline & paravertebral. No focal neurology was present but he had a lot of difficulty trying to get out of bed when asked. You decide to do some plain films:
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What does this plain film show?
It shows a "Chance fracture" of L1.
Otherwise known as 'the seatbelt fracture', this patient has the classic story for flexion injury suffered following vehicle deceleration whilst restrained with only a lap belt (often seen in the middle seat of older cars), thus allowing his upper body to flex forward.
Chance fractures typically involve all 3 'columns' of the spine & are therefore unstable. Also be weary, as they have a high association with intra-abdominal injury.
For our patient, CT went on to confirm its instability & the surgeons proceeded to a T12-L2 fixation.
Otherwise known as 'the seatbelt fracture', this patient has the classic story for flexion injury suffered following vehicle deceleration whilst restrained with only a lap belt (often seen in the middle seat of older cars), thus allowing his upper body to flex forward.
Chance fractures typically involve all 3 'columns' of the spine & are therefore unstable. Also be weary, as they have a high association with intra-abdominal injury.
For our patient, CT went on to confirm its instability & the surgeons proceeded to a T12-L2 fixation.
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