Case discussion
01Clinical context
A young adult man underwent trauma CT assessment following a road traffic collision. This teaching case is based on the case presentation supplied by Dr. Mohammad Azzam Awad; the selected images and clip illustrate the spinal injury and do not replace review of the complete examination.
02Key imaging findings
CT demonstrated a Chance-type flexion-distraction fracture of L1, extending transversely through the vertebral body and superior endplate, both pedicles, and posterior osseous elements. An anterior-superior vertebral body fracture component and focal post-traumatic kyphotic angulation were present. The supplied complete-examination report also described right L1 and L2 transverse process fractures and bilateral pulmonary contusions, greater on the right. No acute thoracic spine, rib or pelvic fracture, abdominal solid-organ injury, hemoperitoneum, free air, acute cervical fracture or acute intracranial traumatic finding was reported. These additional findings are reported from the complete examination and are not all demonstrated in the selected figures.
03Diagnostic reasoning
The supplied discussion emphasizes assessment of the posterior tension band and full osseous injury. MRI may be considered when there is concern for posterior ligamentous complex injury, spinal canal compromise or neurological symptoms. No ligamentous MRI assessment or clinical outcome is provided in this case.
04Teaching point
A horizontal fracture extending from the posterior elements through both pedicles into the vertebral body should prompt recognition of a Chance-type flexion-distraction injury. Multiplanar CT reformations help define its full osseous extent. Highlight associated kyphotic angulation and report additional transverse process fractures separately. Such injuries may be mechanically unstable; imaging morphology alone does not establish the patient's clinical stability or outcome. Review the remaining thoracoabdominal examination for associated injuries.
Shown for education. De-identified — no identifiable patient data. A radiology report is a specialist opinion and must be read with the full clinical context by the treating physician.