Isolated Upper Thoracic Chance Fracture with Neurological Deficit, Without Bone Injury, Case Report

Case Report

Austin J Orthopade & Rheumatol. 2014;1(2): 2.

Isolated Upper Thoracic Chance Fracture with Neurological Deficit, Without Bone Injury, Case Report

Meriç Unal1*, Ahmet Cemil Turan2 and Omer Akçali3

1IspartaSifa Hospital Orthopaedics and Traumatology, Isparta/Turkey

2Izmir Medical Park Hospital Orthopaedics and Traumatology, Izmir/Turkey

3DokuzEylül University Faculty of Medicine Orthopaedics and Traumatology, Izmir/Turkey

*Corresponding author: Meric Unal, Isparta Sifa Hospital, Department of Orthopaedics and Traumatology, Isparta/Turkey

Received: October 10, 2014; Accepted: October 27, 2014; Published: November 04, 2014


Chance fracture is known as horizontal splitting of vertebral corpus and neural arc. Mostly seen mechanism is hyperflexion of vertebra [1,2,3,4]. Horizontal splitting includes vertebral corpus, intervertebral discs or both [2]. Mostly seen at thoracolumbar region [3]. Upper thoracic chance fracture is very rare [1]. Injury mechanism is usually flexion-distraction injury and usually seen as seat belt injury at the time of car crush [1,3,4].

In this case report, patient had spinal cord injury caused by traffic accident outside car. There were no bone injury detected at direct radiography, computed tomography (CT) and magnetic resonance imaging (MRI) but there was T1-T2 intervertebral disc horizontal splitting and interspinous and supraspinous ligament separation at the same level.


70 year old male examined after car crush. At neurological examination, total loss of bilateral lower extremity muscle strength and hypoestesia under second thoracic vertebra. There was no anal tonus and sense. Bulbocavernous reflex was not detected. Abdominal skin reflex also could not detect bilaterally. Bilateral upper extremity examination was normal. There were no other problems at systemic examination.

Direct radiography, includes all vertebras was taken (Figure 1,2). Lateral radiography at swimmer position was also taken for exact determination of cervicothoracic junction. There were no abnormalities found at direct radiographic examination. At the thin slice CT examination, there were no bony lesions found (Figure 3).