title: Pediatric chance fracture associated with pedicle screw use: a case report.
abstract: METHODS
  A previously undescribed clinic entity is presented, along with suggestions to prevent its reoccurrence.
  
  
  OBJECTIVE
  To identify a potential pitfall in the use of pedicle screw instrumentation in trauma cases. Also, to emphasize the need to identify and treat noncontiguous spinal fractures.
  
  
  BACKGROUND
  No previous cases have yet been described with this particular complication, which would be remedied easily with established methods. Pedicle screw instrumentation previously has been associated primarily with complications due to aberrant screw insertion and injury to adjoining tissues, or due to fracture of the construct itself in the absence of fusion formation.
  
  
  METHODS
  A 15-year-old girl suffered a traumatic T12-L1 fracture dislocation and paraplegia. After pedicle screw instrumentation, her apparently benign L3 fracture progressed to a severely displaced Chance fracture. This was repaired with caudal laminar hook compression instrumentation.
  
  
  RESULTS
  Postoperatively, at a 1-year follow-up, the patient's spinal deformity was completely alleviated, though she remains paraplegic.
  
  
  CONCLUSIONS
  Unstable traumatic spinal injuries treated with pedicular instrumentation should have additional laminar hook compression configuration reinforcement at the ends of the constructs to prevent further stress-induced injury from the screws alone. Instrumentation constructs should not end at even minimally fractured levels.
authors.affiliation: Orthopaedics Indianapolis Inc., Indiana, USA.
authors.forename: M F
authors.initials: MF
authors.lastname: Coscia
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D001863:Bone Screws / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000209:etiology; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D012086:Reoperation; D016103:Spinal Fractures / Q000601:surgery*