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Case 32 - Chance Fracture

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We've moved from the cervical spine fractures into the

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thoracolumbar fracture. Let's look at this fracture.

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We're at 5, 4, 3, 2, 1, the T12 vertebra,

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and we see that it has decreased height.

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And it looks like there are portions of the vertebra both

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the anterior as well as posterior portions that are

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fractured. This is not a typical compression fracture.

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This is fragmented. And not only that,

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but we see that there's a fracture across the facet joint

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extending actually into the spinous process of the

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vertebral body above. And on the other side,

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again, fracture of the facet as well as extending into the pedicle.

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On the axial scans through the fracture, we see the posterior

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fragment projecting into the spinal canal.

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Although, doesn't really look like it's compromising

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the spinal canal AP diameter that much.

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Here we have the comminution of the fracture,

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but this fracture also extends, as you can see,

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into the junction of the lamina and the transverse

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process bilaterally, and then across the pedicle.

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Here we are at the pedicle level.

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So this is a fracture that not only goes from anteriorly,

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the vertebral body,

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but also extends into the posterior elements.

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And that's one of the components of a chance fracture.

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This chance fracture, as you would expect,

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is involving three columns.

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The anterior half of the vertebral body,

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the posterior half of the vertebral body,

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as well as the posterior elements,

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and therefore is considered in the DENIS classification,

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three-column injury and therefore unstable.

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So.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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