Abstract
Introduction: Chance fractures in children are rare the mechanism of injury is a flexion-distraction inertial force created during a motor vehicle accident when wearing a two-point seat belt or lap belt. High velocity paediatric Chance fractures are frequently associated with intra-abdominal injuries, although this may not be appreciated at the time of initial presentation.
Methods: The cases of two brothers who sustained Chance fractures with complete neurological deficits and intra-abdominal injuries from a motor vehicle accident are presented.
Results: The two brothers were rear seat passengers in car involved in a head-on collision with a tree. They were both wearing three point seat belts but had removed the chest straps, thus effectively converting them to a two-point harness.
Case 1. Boy age 3 years 10 months sustained a bony Chance fracture through the L3 vertebrae with a complete neurological deficit at the L1 level. There was an associated closed head injury and severe abdominal bruising. He underwent a CT scan of his abdomen on day of admission and posterior stabilisation of the spinal fracture on day 4. Seven days post-admission he was diagnosed with pancreatitis. He continued to have abdominal pain and vomiting. Further repeat abdominal CT scans, ultrasound examinations and abdominal contrast studies were performed. Ten weeks following admission he underwent laparotomy and a section of ischaemic small bowel was removed.
Case 2. Boy age 2 years 8 months presented with a ligamentous Chance fracture of L2 / L3 with a complete neurological deficit at T12. He had a closed head injury and severe abdominal bruising. He underwent CT scan on the day of admission and a diagnostic peritoneal tap on day two with aspiration of straw coloured fluid. The spinal fracture was stabilised 10 days post-admission with posterior instrumentation. On day 14 he underwent a laparoscopy and subsequent laparotomy with drainage of an abscess secondary to a perforated caecum.
Discussion: Chance fractures or flexion-distraction fractures of the spine are rare occurrences in children with few cases reported. They represent severe trauma and are often related to the wearing of two-point seat belt fixation. There is a high associated incidence of abdominal injuries which may be difficult to diagnose. The authors support the view of Beaunoyer1 that a diagnostic laparoscopy or laparotomy should be considered strongly in patients with lumbar Chance fractures. Abdominal bruising and neurological defi cit are cardinal signs, reflecting severe trauma.
The abstracts were prepared by I. B. McPhee. Correspondence should be addressed to the Spine Society of Australia Secretariat, The Adelaide Centre for Spinal Research, Institute of Medical and Veterinary Science, PO Box 14, Rundle Mall, Adelaide SA 5000, Australia.
References:
1. Beaunoyer M, St-Vil D, Lallier M, Blanchard H. Abdominal injuries associated with thoracolumbar fractures after motor vehicle collision. J Paediatric Surg2001; 36:760–762. Google Scholar
