Unusual Mechanism of Injury Resulting in a Thoracic Chance Fracture in a Rodeo Athlete: A Case Report

Abstract

Objective: To introduce the characteristics of a Chance fracture and increase awareness of the mechanism of injury that may occur during athletic activity. Background: A T12 Chance fracture was diagnosed in an 18-year-old male rodeo athlete. The rider was forced into extreme lumbothoracic hyperflexion when the horse bucked within the chute, pinning the rider's legs to his chest. Differential Diagnosis: Burst fracture, abdominal organ rupture, spinal dislocation, spinal cord injury, disk herniation, pars interarticularis fracture, spinal nerve injury, paralysis. Treatment: The patient underwent an open reduction and fixation of the thoracic fracture. Posterior stabilization was obtained with nonsegmental instrumentation. Allograft and autografts were used for posterolateral arthrodesis at T11–T12 and T12–L1. Uniqueness: Motor vehicle crashes with occupants wearing lap-type–only restraints account for nearly all previously reported Chance fractures. When only lap seatbelts are worn, the pelvis is stabilized, and the torso continues moving forward with impact. The stabilized body segment for this individual was reversed. Nearly 3 years after the initial surgery, fixation, and infection, the bareback rider has returned to full participation in rodeo. Conclusions: To our knowledge, this is the first reported diagnosis of a T12 Chance fracture in a rodeo athlete. When animals buck, athletes can be forced into hyperflexion, exposing them to Chance fractures. Therefore, anyone treating rodeo athletes must suspect possible spinal fracture when this mechanism is present and must treat all athletes with early conservative management and hospital referral.