• Miguel Couselo, Estíbaliz Valdés, Carlos Gutiérrez, Verónica Marijuán, Javier Lluna, and Carlos García-Sala.
• Pediatric Surgery Department, Hospital La Fe, Valencia, Spain. miguelcjerez@hotmail.com
• Pediatr Emerg Care. 2011 Jun 1;27(6):553-5.

AbstractTraumatic diaphragmatic injuries are uncommon in children. Chance fractures are typical in adults who had motor vehicle accidents but infrequent in children. The seat belt syndrome is characterized by a spectrum of injuries caused by the compression of the abdomen by the seat belt. It can affect the abdominal wall, hollow or solid organs, and the spine, but the association between diaphragmatic rupture and Chance fracture is extremely rare. We describe the case of a child who was involved in a car accident and who presented with multiple traumas; liver and lung injuries were first detected, and the patient was managed accordingly. During the hospital stay, a right diaphragmatic avulsion and a Chance fracture, which were initially missed, were diagnosed and treated successfully. The relevance of this case lies in the low incidence of the diaphragmatic rupture and the Chance fracture in children along with their exceptional association and in the diagnosis, which might be especially difficult in the acute setting.

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