Chance Fracture Pattern Presenting in Proximal Junctional Failure.
J Am Acad Orthop Surg Glob Res Rev
; 7(8)2023 08 01.
Article
en En
| MEDLINE
| ID: mdl-37540797
INTRODUCTION: We present a case series of proximal junctional failure due to a Chance-type fracture. METHODS: This is a retrospective review of patients who developed proximal junctional kyphosis because of Chance-type proximal junctional failure after spinal fusion for adult spinal deformity. RESULTS: Fifteen patients were identified (4M:11F). The average age was 61.4 years (range, 39 to 77). The mean time to fracture identification was 25.4 days (range, 3 to 65). The average number of levels instrumented was 6.7 (range, 2 to 17). No patients had antecedent trauma before fracture onset. In 67% of cases with a lumbar upper instrumented vertebra (UIV), there was overcorrection of lumbar lordosis (LL) and/or lower LL. The five cases with a lower thoracic UIV had undergone notable correction of preoperative thoracolumbar junction kyphosis. 14 of 15 patients were treated with extension of fusion. Pedicle screws at the fracture level were salvaged by changing to an anatomic trajectory. CONCLUSION: Continued pain at 6 to 12 weeks with radiographs showing an increased proximal junctional angle and cephalocaudal pedicle widening at the UIV should raise suspicion for this unique fracture pattern. A CT scan is recommended. Low bone density, LL and/or lower LL overcorrection, and selection of lower thoracic UIV in the setting of notable thoracolumbar junction correction may contribute to fracture risk.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Fracturas Óseas
/
Cifosis
/
Lordosis
Tipo de estudio:
Etiology_studies
/
Prognostic_studies
Límite:
Adult
/
Humans
/
Middle aged
Idioma:
En
Revista:
J Am Acad Orthop Surg Glob Res Rev
Año:
2023
Tipo del documento:
Article
Pais de publicación:
Estados Unidos