Seat belt syndrome with unstable Chance fracture dislocation of the second lumbar vertebra without neurological deficits

Abstract

The seat belt syndrome is a recognised complication of seat belt use in vehicles. Unstable Chance fractures of the spine without neurological deficits have been reported infrequently. We describe a young woman with completely disrupted Chance fracture of the second lumbar vertebra in association with left hemidiaphragmatic rupture/hernia, multiple bowel perforations, splenic capsular tear, left humeral shaft and multiple rib fractures. These injuries which resulted from high-speed vehicle collision and led to death of one of the occupants were readily detected by trauma series imaging. The patient was successfully treated by a dedicated multidisciplinary team which adopted a staged surgical approach and prioritisation of care. There were no manifested neurological or other deficits after 1 year of follow-up. To the authors' knowledge, this is the first report of such a case in Australasia. We discuss the challenging surgical management, highlighting the role of radiological imaging in such cases and provide a literature review.

Fracture and dislocation of lumbar vertebrae with entrapment of small bowel: A case report and literature review

“…5,8,11 The three patients sustained a ‘lap-belt injury’, described as a special injury pattern frequently observed in motor vehicle collisions. 15–21 The sudden deceleration force results in compression of the intra-abdominal organs between the lap belt and the lumbar spine, and a hyperflexion-distraction injury known as a ‘Chance fracture’, which presents with impaction of the anterior components and distraction of the posterior components of the spine. 22–24 The most common intestinal injury is perforation and the most common site is the jejunum.…”

Traumatic Lumbar Spondylolisthesis: A Systematic Review and Case Series

“…5,17 -23 The hyperflexion mechanism usually results from seat-belt or lap-belt injuries during a motor vehicle accident. 17,24 The high-energy impact leads to failure of bony facets and/or soft tissue disruption resulting in anterolisthesis. The shift from a sagittal-oriented thoracolumbar facet joint to a coronal-oriented L5-S1 facet joint explains the predisposition to dislocation and listhesis.…”

An Unusual Blunt Traumatic Retro-Aortic Hernia

“…Traumatic lumbar hernia is defined as "a protrusion of abdominal contents through a defect in the abdominal fascia and muscles within the lumbar region." 1 Acquired hernias, whether surgical or traumatic, account for 80 per cent of all lumbar hernias, of which 45 per cent has been noted to be secondary to trauma, infection, or prior surgery. 1 They are rare and are usually accompanied by blunt abdominal trauma, such as in a seatbelt injury.…”

“…1 Acquired hernias, whether surgical or traumatic, account for 80 per cent of all lumbar hernias, of which 45 per cent has been noted to be secondary to trauma, infection, or prior surgery. 1 They are rare and are usually accompanied by blunt abdominal trauma, such as in a seatbelt injury. 1,2 It is an unusual injury and when presented can be a challenge for the trauma surgeon.…”