Chance fracture missed by convencional CT: Presentation of a clinical course

Abstract

Bending-disruption fractures of the vertebral body are called Chance fracture. In some cases these fractures may not be noticeable with a CT scan. A 9 years-old boy suffered a frontal collision while traveling in the back seat of a car. The child was secured by the safetybelt, without a child car seat or elevator adapted to his height. He had abdominal skin lesions in the physical exploration compatible with a belt mark. Conventional thoraco- abdominal CT scan did not show any vertebral fracture. As the clinical suspicion persisted, lateral plain radiography of the lumbar column was performed showing a Chance fracture in L2, confirmed by MRI. Chance fracture is typically seen in children under 12 years less than 135 cm height and with injuries associated with the belt after a traffic accident. This type of fractures may go unnoticed in a conventional CT scan so clinical suspicion must lead us to further work-up. The MRI is the gold standard for the diagnosis. This case remarks the importance of the use of homologated elevated seat devices in older children.