Chance equivalent fracture

Findings

Subtle kyphosis at L2/L3 with bipedicle fracture and L1-L3 right transverse process fractures


Diagnosis: Chance equivalent fracture


Key points

Thoracolumbar junction fractures are classified based on mechanism of injury as determined by middle column.
Chance fractures result from anterior hyperflexion, usually across a lap belt.
There is often a horizontal fracture through the vertebral body, pedicles, lamina, and spinous process.
Chance equivalent occurs when the injury is primarily ligamentous.
Chance equivalent may demonstrate mild widening of the posterior intervertebral disc space, facet widening, or splaying of spinous processes.
In both Chance and Chance equivalent, infrequently (20%) there is a neurologic deficit.
50% of the time there is an associated bowel injury.
Almost always occurs at L2 or L3.
Usually this is an unstable fracture.
If there is a neurologic deficit, the patient will likely need surgery. Otherwise they can often be treated with a brace.