LAUSR

Primary diagnostic tool seems to be the CT scan as a gold standard to recognize all bone lesions of the entire spine and its environment. MRI shows additional soft tissue lesions or edema of the cord, but the indication for the op. procedure is given by the CT. In the case of thoracic Chance fracture, the rib cage has to be inspected to detect additional signs of instability. The present case showed undisplaced fracture of the sternum, which underscores that the whole thorax was object to unchecked flexion. These potential rib or sternal fractures or even lacerations of intrathoracic organs are thus not only concomitant lesions, but also express the nature of the injury. The 2013 published revision [1] of the Magerl classification [2] places this spine injury into the B-category (failure of the post. osseous or ligamentous tension band). As a consequence, the reconstruction of this major structure is a must and represents the prerequisite for restoration of an unlimited mobility of the patient. To minimize the operative trauma, minimal-invasive techniques have to be preferred [3]. Undoubtedly, an elaborated operative technique for transpedicular fixation is needed. The thoracic spine requires special skills and partly extra-anatomical drilling technique (in–out–in technique). If there is a need for decompression by laminectomy you have to compensate the resulting instability by an appropriate posterior instrumentation length. Especially, in high thoracic situated lesions brace treatment is obsolete because this technique is not able to stop flexion moments above T5. When G.Q. Chance in 1948 first reported on a type of flexion fracture of the spine, little was known about the biomechanical implications and especially the impact of this injury, which resulted not only in this type of fracture, but also in a typical pattern of additional lesions as a result of this very special mechanism of injury. This Grand Rounds case report highlights some of these aspects and at the same time shows that it is indispensable that a spine surgeon is able to detect all the potential markers, which shows the way to diagnosis and thus the way to appropriate treatment. Or vice versa, if you realize the typical appearance of a Chance fracture of a vertebral segment you search for the potential additional lesions, which are to wait in this kind of injury.