Pediatric chance fractures from lapbelts: unique case report of three in one accident

In 1948, G. Q. Chance described a traumatic spinal injury as a "horizontal splitting of the spine," which has since come to be known as the Chance fracture. In 1965, the first such fracture was described by Howland et al. in a passenger as a result of a lap seatbelt during a motor vehicle accident. Until 1980, there were 36 such injuries reported, but the number of reports has since risen with the advent of mandatory seatbelt laws. We report three cases occurring in a single accident when a popular 4-wheel drive vehicle moving at only approximately 25 mph struck a tree, causing flexion-distraction fractures in all three children wearing lapbelts while seated in the rear seat. All three had a different Chance fracture variant and associated intraabdominal injuries. One child was rendered paraplegic. The purpose of this report is to promote awareness of the associated injuries, and to encourage appropriate use and development of passenger restraints for children.