Chance Fracture in Three Brothers

Abstract

Chance fracture, suggestive of a flexion-distraction mechanism, is an uncommon type of injury in the pediatric population. Its occurrence, with associated intra-abdomimal lesions, has increased with the widespread use of seat belts. Since this type of fracture presents subtle variations on common image examinations, its diagnosis may be delayed increasing the probability of subsequent neurologic deficits. In this paper we report the case of three siblings, victims of a motor vehicle head-on collision,either presenting seat belt fracture or Chance fracture. They were treated in the Hospital João XXIII, Belo Horizonte. The case reported reinforces the hypothesis describing the fracture mechanism and associated intra-abdominal injuries.

Chance Fracture in an Unbelted Rear Seat Passenger

“…[35] Intra-abdominal lesions are encountered in 30%–50% of Chance fracture patients. [12] The index patient was an unbelted victim of a lone motor vehicular accident and she had no clinical or radiologically confirmed abdominal injury probably because she was not on seat belt. The right hip dislocation and left femoral shaft fracture implied that the primary impact on both lower limbs was unbalanced probably leading to the twisting of the thoracolumbar spine and causing secondary spinal injury.…”

“…[3] Neurological deficit occurs in about 1.4% but may be as high as 10.5% if diagnosis is delayed. [2] There was no neurological deficit in the index case, and the initial limitation of the lower limbs movement was due to the right hip fracture dislocation and left femoral shaft fracture. The radiologic findings may be subtle.…”

“…[7] It usually requires stabilization procedures either by internal or external fixation. [234] The treatment of this type of fracture depends on the severity of the injury regarding the neurological status and anatomical patterns of the fracture. Conservative treatment may be sufficient for bony lesions in patients without neurological deficits.…”

“…It occurs commonly in patients wearing seat belts; however, it has also been reported in unbelted individuals. [1234] There was a case report of a 21-year old man who slid down a flight of stairs and subsequently sustained chance fracture of the first lumbar vertebrae. [5] Chance fracture is an uncommon injury in an unbelted victim of lone motor vehicular accident.…”