Disclosures: Matthew A. Cascio, DO: No financial relationships or conflicts of interest

Case Diagnosis: Chance fracture following motor vehicle collision

Case Description or Program Description: A 17-year-old male with a history of Criggler-Najar syndrome presented as a level one trauma following a motor vehicle collision as a restrained passenger. He noted low back pain and bilateral lower extremity weakness. CT and MRI demonstrated T12 Chance fracture with lamina and superior articular process fracture and retropulsion to the spinal cord. He underwent ORIF with posterior spinal fusion of T10-T12 with T11-T12 hemilaminectomy. He was provided a thoracolumbosacral orthosis (TLSO) brace for ambulation.

Setting: Tertiary-care teaching hospital

Assessment/Results: He was transferred to acute inpatient rehabilitation, at which time he continued endorsing right ankle and foot numbness. He ambulated ten feet utilizing a rolling walker. After a two week inpatient rehabilitation stay, he ambulated three hundred feet independently without an assistive device and negotiated twelve stairs. His back pain and right lower extremity numbness resolved during admission. On follow-up two months after rehabilitation discharge, he had returned to school and continued with improvements in ambulation.

Discussion (relevance): A Chance fracture is an unstable fracture extending from posterior to anterior through vertebrae, typically at the thoracolumbar junction. It is associated with rapid deceleration in a motor vehicle collision. Neurologic deficits are rare; however, intra-abdominal injury is often associated. Diagnosis involves CT to assess spinal injury and intra-abdominal injury, with MRI indicated when concerned for spinal cord injury/compression. Patients without neurological deficits may be managed conservatively, including casting or bracing, while patients with neurological deficits may require posterior fixation with or without interbody fusion. Early mobilization, including physical therapy, is crucial after surgery.

Conclusions: Early diagnosis of a Chance fracture with associated neurologic deficits in our patient led to prompt surgical repair and initiation of therapy. Chance fractures should be considered in patients with back pain, particularly following motor vehicle collisions.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-chance-to-walk-again-a-case-of-chance-fracture-following-motor-vehicle-collision-in-a-pediatric-patient/