[Seat-belt and chance fractures of the thoracolumbar spine].
BACKGROUND
The authors have attempted to elucidate the differences between Chance, seat-belt, and flexion distraction fractures. Chance and seat-belt fractures have more common features, while flexion distraction fractures differ, in particular, due to the mechanism of injury. A difficult diagnosis is sometimes a common characteristic, while therapy is always the same.


METHODS
During the period from 1997 to 2005, the authors treated 23 seat-belt fractures, and only three "genuine" Chance fractures. All patients had normal neurological findings. The mechanisms of injury were a car crash in 20 cases, and a fall associated with flexion in 6 cases, such as a rolling fall while skiing. According to the localisation, Chance fractures were found at the L 1 level twice and at the L 2 level once. Seat-belt injury was found once each in the areas of T 7, L 4, L 5, -twice at L 2 and L 3, and 16 times at the T / L spine transition, respectively. All patients were operated on using instrumented posterolateral spondylodesis.


RESULTS
All fractures healed by spondylodesis as confirmed by X-ray images. All patients returned to their original job or school. 14 patients were evaluated 6 months after removal of the metallic implants. The mean subsequent kyphotisation was 1.4 degrees with the largest deviation of 4 degrees in a patient with a pure ligamentous variant of a seat-belt fracture.


CONCLUSIONS
The objective of this work is to illustrate the various types of spinal distraction injuries of a seat-belt character and Chance fracture, when the vertebral body is not compressed. X-rays and often also CT scans show a "benign" character. Interpretation of the findings is very important for the development of further chronic instability of the spine and all consequences. If the diagnosis of a distraction injury is made the operative stabilisation is essential. That is why all our patients were tretaed by operation.
Matejka
J
J
Klinik für Orthopädie und Traumatologie des Bewegungsapparates, Medizinische Fakultät der Karls-Universität und Universitätskrankenhaus Pilsen.
Zeman
J
J
Belatka
J
J
Nepras
P
P
Houcek
P
P
Linhart
M
M
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D016025:Bone Transplantation; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012622:Seat Belts / Q000009:adverse effects*; D012865:Skiing / Q000293:injuries*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D055815:Young Adult