Management of a high thoracic chance fracture

Eur Spine J. 2018 Jul;27(7):1547-1552. doi: 10.1007/s00586-017-5247-8. Epub 2017 Aug 9.

Abstract

Purpose: Chance fracture of the high thoracic spine is rare, and its impact on the adjacent cervical spine can be important.

Methods: We present the case of a 16-year-old male, who fell down from a 2 m height, in an unknown context as he has a mental retardation, and no witness saw the accident. Initial CT scan revealed a comminuted depressed fracture of the right parietal bone, associated with a chance fracture at the level of T3 with a kyphosis and bilateral lung contusion.

Results: The patient underwent neurosurgical treatment for elevation and reconstruction of the parietal fracture; he also underwent, 2 days later, a posterior spinal correction and fusion with T1-to-T5 instrumentation. The patient returned to normal walking on day 7 with a satisfactory clinical and radiological result at 1 year.

Conclusion: Literature is sparse on the treatment of high thoracic chance fractures. The current case shows that early surgical management should prevent a secondary kyphotic deformity that may need a more aggressive treatment at a later stage.

Keywords: Chance fracture; High thoracic; Kyphosis; Posterior approach; Sagittal alignment.

MeSH terms

  • Adolescent
  • Humans
  • Male
  • Spinal Fractures* / diagnostic imaging
  • Spinal Fractures* / surgery
  • Thoracic Vertebrae* / diagnostic imaging
  • Thoracic Vertebrae* / surgery