![]() ![]() If a patient presents with signs of spinal cord injury, and the CT scan or MRI shows a high likelihood of injury to the spinal cord, then surgery is recommended. The treatment of a Chance Fracture first depends on degree of neurologic symptoms. All of this information is critical when doctors decide on a plan of treatment. By assessing where a patient is feeling muscle weakness or numbness, doctors are able to pin point which vertebrae in the spine are likely to be damaged. In addition to getting all of these images of the spine, a very detailed neurologic examination is necessary to determine the degree of spinal cord damage, and also to localize the site of injury. They are very helpful in showing spine fractures (broken vertebrae) or vertebrae displacement, however, a MRI is often ordered as well to look for injury to the spinal ligaments and the spinal cord itself (a CT scan is great at showing bones, but not very helpful in showing soft tissue injury, like tendons, ligaments, and nerves). X-rays are often the first step in evaluating a spine injury, however, these days may Emergency Rooms that treat high energy trauma will take patients directly to the CAT scanner before getting x-rays. CAT scans are best thought of as a collection of many x-ray slices, which are taken from multiple angles, that provide a 3D picture of the spine. How is a Spine Chance Fracture diagnosed? A Chance Fracture is suspected when a person complains of severe back pain after a high-energy injury. Injury to both the front and the back of the spine requires a lot of force and so doctors are mainly concerned for a Chance Fracture during a high speed accident (its much less common to occur after a fall from standing, or from lifting a heavy box, for example). In the case of a Chance Fracture, the ligaments along the back of the spine (the middle and posterior spine column) are under significant tension (they are being pulled apart), while the bone in the front of the spine (the anterior column) is compressed (its being squished). However, if there is a big enough force acting on the spinal column, these ligaments can tear, and then vertebrae can shift out of position (now the holes don't line up and the spinal cord doesn't have a clear path). During normal bending or twisting, there are many strong ligaments that hold the vertebral bodies in position to prevent any displacement which could damage the spinal cord. Patient’s with Chance fractures should have appropriate imaging of their abdomen and pelvis if not already imaged.The spine has mobility, and this is great because it allows us to bend and twist our torso. Delayed recognition of associated intra-abdominal injuries may contribute to significant morbidity and mortality. Radiologists should always have a high index of suspicion for Chance fractures in the appropriate clinical context. The patient also had spinal surgery for her Chance fracture. There was no spinal cord impingement on a subsequent MRI.Ĭonclusions: This patient went on to have a laparotomy, for repair of a blowout perforation of the proximal jejunum and mesenteric tear. Perihepatic and pelvic fluid was visualised, which was felt to be haemorrhagic based on fluid density. Close to the duodenojejunal junction, circumferential mural thickening of the proximal jejunal loops was noted. There were non-displaced fractures of the left transverse processes of 元 & L4. Results: A CT scan demonstrated an L4 Chance fracture, with 10% loss of vertebral body height, extending to the left pedicle and crossing the left facet. We also present an overview of the radiological features of Chance fractures. We outline their injuries sustained and radiological findings. Methods: We present the case of a 19-year-old patient who was a restrained front-seat passenger in a high-velocity road traffic accident. General surgical and spinal surgical input is often required in these patients. Approximately 40% of patients with Chance fractures have associated intra-abdominal injuries. Policy of Dealing with Allegations of Research Misconductīackground: A Chance fracture is a flexion-distraction injury of the thoracolumbar spine, which involves all three spinal columns.Policy of Screening for Plagiarism Process.
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