Question

A man met with an RTA and came to the emergency department with complaint 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 vertebra
• D. Chance fracture

Hint:

Seat-belt + flexion-distraction over a lap belt produces a horizontal fracture across the whole vertebra — think of the eponymous “seat-belt fracture.”

Answer 1

The Correct Option is D

Step 1: Set the clinical context. A road traffic accident (RTA) is a classic high-energy flexion-distraction mechanism - typically a seat-belted occupant thrown forward over a lap belt. The fulcrum is the anterior abdominal wall, so the spine fails in distraction (pulling apart) posteriorly while the anterior column may stay intact or compress only mildly.

Step 2: Why Chance fracture (Option D) is correct. A Chance fracture is a horizontal fracture that runs through the vertebral body, pedicles and spinous process - a transverse "seat-belt" injury caused by flexion-distraction. On the lateral X-ray it appears as a horizontal split widening posteriorly. It is a recognised RTA/seat-belt injury and can present with only back pain and no neurological deficit if the cord is spared, exactly as described.

Step 3: Why the other options are wrong.
• Fracture of spinous process (A) is an isolated avulsion (e.g. clay-shoveller's fracture) and does not involve the body or pedicles through a horizontal plane.
• Compression fracture (B) is anterior wedging of the body from pure axial/flexion load; the posterior elements remain intact and there is no distraction - it does not match the seat-belt mechanism.
• Fracture of base of vertebra (C) is not a standard spinal fracture pattern and does not describe the horizontal through-and-through injury seen here.

Final answer: D (Chance fracture).