Management of a high thoracic chance fracture

[摘要] Case presentationA 16-year-old male fell down from a 2 m height, in an unknown context as he has a mental retardation, and no witness saw the falling episode. The initial medical assessment made by the emergency team found a man with an altered conscious level and a Glasgow Coma Scale of 9/15 associated with a severe upper thoracic pain with hemiparesis of the left side. No other injuries were noted. The patient was transported immediately to the hospital for further evaluation and investigations. Upon arrival to the emergency room, the patient’s conscious level improved and he was alert and oriented, but motor exam revealed a partial deficit of the left upper and lower extremities of 4/5 with paresthesia. A full body CT scan was performed and revealed a depressed fracture of the right parietal bone with an extradural hematoma, associated with a chance fracture of T3 with secondary kyphosis. The patient was taken to the operating room for elevation and reconstruction of the skull fracture by the neurosurgeon. After 48 h of his admission, while still intubated in the Intensive Care Unit, he underwent posterior spinal correction and fusion with T1-to-T5 instrumentation.

[学科分类] 骨科学

[关键词] Chance fracture;High thoracic;Kyphosis;Sagittal alignment;Posterior approach