A 19-year-old restrained car passenger presents after a high speed frontal collision wearing a lap-only belt. Radiographs show a horizontal fracture line running through the pedicle and posterior elements of L2 and extending into the vertebral body. Which accompanying finding should be actively sought in this injury?

• A Injury to intra-abdominal viscera such as bowel or pancreas ✓
• B Bilateral vocal cord paralysis
• C Traumatic diaphragmatic rupture from cephalad displacement of abdominal contents
• D Vertebral artery dissection at the craniocervical junction

Explanation

This is a Chance fracture, produced by flexion-distraction forces, classically from a lap belt acting as a fulcrum. The horizontal split extends through bone or soft tissue across all three columns, making the injury mechanically unstable and usually requiring posterior instrumentation. Because the force vector drives the abdomen against the belt, there is a strong association with hollow viscus and solid organ injury, so abdominal imaging and serial examination are mandatory.

Reference: Apley's System of Orthopaedics and Fractures, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.