title: Seat belt syndrome with unstable Chance fracture dislocation of the second lumbar vertebra without neurological deficits.
abstract: The seat belt syndrome is a recognised complication of seat belt use in vehicles. Unstable Chance fractures of the spine without neurological deficits have been reported infrequently. We describe a young woman with completely disrupted Chance fracture of the second lumbar vertebra in association with left hemidiaphragmatic rupture/hernia, multiple bowel perforations, splenic capsular tear, left humeral shaft and multiple rib fractures. These injuries which resulted from high-speed vehicle collision and led to death of one of the occupants were readily detected by trauma series imaging. The patient was successfully treated by a dedicated multidisciplinary team which adopted a staged surgical approach and prioritisation of care. There were no manifested neurological or other deficits after 1 year of follow-up. To the authors' knowledge, this is the first report of such a case in Australasia. We discuss the challenging surgical management, highlighting the role of radiological imaging in such cases and provide a literature review.
authors.affiliation: Department of Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia.
authors.forename: David O
authors.initials: DO
authors.lastname: Onu
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Hunn
authors.forename: Robert D
authors.initials: RD
authors.lastname: Bohmer
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D003299:Cooperative Behavior; D005260:Female; D018460:Fractures, Comminuted / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D004204:Joint Dislocations / Q000175:diagnosis* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D009104:Multiple Trauma / Q000175:diagnosis* / Q000601:surgery; D009460:Neurologic Examination; D010348:Patient Care Team; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis; D012622:Seat Belts / Q000009:adverse effects*; D016103:Spinal Fractures / Q000175:diagnosis* / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods; D013577:Syndrome; D014057:Tomography, X-Ray Computed