A 30-year-old man involved in a high-speed road traffic accident was wearing a lap-only seatbelt. CT of the abdomen and lumbar spine shows a transverse fracture through the L2 vertebral body, pedicles and spinous process with distraction posteriorly. What is the classification and key association of this injury?

• A Compression fracture, associated with abdominal aortic injury
• B Chance fracture, associated with intra-abdominal visceral injury ✓
• C Burst fracture, associated with cauda equina syndrome
• D Fracture-dislocation, associated with spinal cord transection

Explanation

A Chance fracture is a flexion-distraction injury classically caused by a lap-type seatbelt during sudden deceleration. The fracture line passes horizontally through the vertebral body, pedicles and posterior elements, producing posterior distraction. Because the restraint acts across the abdomen, up to half of cases have concomitant hollow viscus or mesenteric injuries, so abdominal evaluation is mandatory. Burst fractures result from axial compression with retropulsion into the canal, a completely different mechanism.

Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.

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