Question

A man meets with an RTA and comes to the emergency department with complaints of back pain. No neurological deficit. X-ray spine done. What will be the diagnosis?

• A. Fracture of spinous process
• B. Compressed fracture
• C. Fracture of base of vertebrae
• D. Chance fracture

Hint:

Chance fractures are associated with high-energy trauma and are often seen in RTAs. They can be diagnosed with lateral X-rays of the spine showing horizontal fractures.

Answer 1

The Correct Option is D

To determine the diagnosis based on the information provided:
A man has been involved in a road traffic accident (RTA) and presents with back pain but no neurological deficit. An X-ray of the spine is performed. We have four possible diagnoses:

1. Fracture of spinous process
2. Compressed fracture
3. Fracture of base of vertebrae
4. Chance fracture

The key points to consider in making the correct diagnosis in this scenario are:

• The presence of back pain following trauma.
• The absence of any neurological deficit.
• The typical mechanism of injury associated with each type of spinal fracture.

Analysis:

• Fracture of the spinous process: This type of fracture usually results from direct trauma to the back. It generally does not cause major neurological deficits but also might not be a common RTA injury without direct impact.
• Compressed fracture: These occur when the bone is crushed, typically due to osteoporosis or significant axial load but might or might not be associated with neurologic deficit. Not commonly solely from RTAs.
• Fracture of the base of the vertebrae: A rare terminology, possibly referring to vertebral body fractures or more complex vertebral involvement, typically warrants consideration of neurological deficit.
• Chance fracture: A flexion-distraction injury of the spine, common in RTAs, especially with seatbelt use. Typically presents with back pain but no neurological deficit unless severe.

Given these considerations, especially the mechanism common to RTAs and the absence of neurologic symptoms, a Chance fracture is the most likely diagnosis.