0:01

We've moved from the cervical spine fractures into the

0:04

thoracolumbar fracture. Let's look at this fracture.

0:08

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

0:12

and we see that it has decreased height.

0:14

And it looks like there are portions of the vertebra both

0:17

the anterior as well as posterior portions that are

0:20

fractured. This is not a typical compression fracture.

0:24

This is fragmented. And not only that,

0:27

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

0:31

extending actually into the spinous process of the

0:33

vertebral body above. And on the other side,

0:37

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

0:43

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

0:49

fragment projecting into the spinal canal.

0:53

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

0:55

the spinal canal AP diameter that much.

0:57

Here we have the comminution of the fracture,

1:00

but this fracture also extends, as you can see,

1:03

into the junction of the lamina and the transverse

1:06

process bilaterally, and then across the pedicle.

1:10

Here we are at the pedicle level.

1:13

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

1:17

the vertebral body,

1:18

but also extends into the posterior elements.

1:21

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

1:26

This chance fracture, as you would expect,

1:29

is involving three columns.

1:32

The anterior half of the vertebral body,

1:34

the posterior half of the vertebral body,

1:35

as well as the posterior elements,

1:38

and therefore is considered in the DENIS classification,

1:41

three-column injury and therefore unstable.

1:45

So.

Case 32 - Chance Fracture

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