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Pediatric Chance Fractures: A Multicenter Perspective

Arkader, Alexandre MD*,†; Warner, William C. Jr MD; Tolo, Vernon T. MD*,†; Sponseller, Paul D. MD§; Skaggs, David L. MD*,†

doi: 10.1097/BPO.0b013e31822f1b0b

Background: Chance fractures or flexion-distraction injuries of the spine are uncommon in children. Previous reports have been limited to isolated case reports or very small retrospective series. This is the largest series reported in the English literature.

Methods: This was a multicenter retrospective review of pediatric Chance fractures treated at 3 large level-1 pediatric trauma centers. We analyzed the demographics, causes, circumstances, treatment, complications, and clinical outcome of 35 patients younger than 18 years old with a Chance fracture. We hypothesize that surgical treatment provides the best results.

Results: There were 20 females and 15 males, with an average age of 9 years (range, 1.6 to 17 y). The most common level of injury was at L2 and L3 (20/35). Fifteen children (43%) had a neurological deficit at the time of injury and only 8 fully recovered. One patient deceased before formal orthopaedic treatment. Patients were treated at the discretion of the surgeon and the surgically treated group (20/34) had greater initial kyphotic deformity (22 degrees) than those treated nonoperatively (14/34; 11.4 degrees) and less posttreatment residual kyphotic deformity (3.5 vs. 20 degrees, respectively). The complication rate related to treatment was 26% (9/34) and most complications in the nonoperative group were related to progression of kyphosis whereas in the surgical group most complications are related to discomfort over the hardware (4 patients). Fifteen children (43%) had neurological deficit at presentation, 7 did not fully recover, for an incidence of permanent neurologic deficit of 10% among restrained patients versus 42% for unrestrained patients. Twenty-one patients (62%) had a good final clinical outcome defined by no chronic pain or neurologic deficit, this represented 45% good outcome in the nonoperative group compared with 84% in the operative group (NS).

Conclusions: In this multicenter retrospective study, surgical treatment of Chance fractures in children seems to produce better clinical outcome, the appropriate use of restraints reduce the incidence of definitive neurologic deficit.

Level of Evidence: Level 3, comparative study.

*Childrens Orthopaedic Center, Childrens Hospital Los Angeles

Keck School of Medicine, University of Southern California, Los Angeles, CA

Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN

§Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD

The authors certify that their institution has approved the publication of this study that all the investigations were conducted in conformity with ethical principles of research, and informed consent was obtained.

The authors declare no conflict of interest.

Reprints: Alexandre Arkader, MD, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 W Sunset Boulevard, Mailstop #69, Los Angeles, CA 90027. E-mail:

© 2011 by Lippincott Williams & Wilkins