A 35-year-old front-seat passenger restrained by a lap belt sustains a flexion-distraction injury in a head-on collision. CT shows a horizontal splitting fracture through the posterior elements and vertebral body of L2 with no neurologic deficit. This injury is best described as a:

• A Chance fracture ✓
• B Burst fracture
• C Compression fracture
• D Fracture-dislocation

Explanation

Chance fracture is a flexion-distraction injury through the vertebral body, posterior elements, and pedicles in a horizontal plane, classically from a lap belt in a frontal collision. It is a bony injury that may heal with hyperextension casting if the posterior ligamentous complex is intact. Burst fracture is axial loading with retropulsion. Compression fracture involves only the anterior column. Fracture-dislocation involves all three columns and is highly unstable.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.