Objectives: To report an unusual pure soft tissue chance fracture located in the thoracic spine.

Methods: We report on a 46-year-old woman who was involved in a road traffic accident. Neurological examination demonstrated paraplegia, while initial CT showed bilateral pneumothorax and haemothorax, rib fractures, a C2 vertebral body fracture with C2-C3 dislocation and active arterial bleeding at the sacral level.

Results: Given the fact that her neurological status did not particularly correspond with what we observed on CT scan, MRI was obtained due to the suspicion that a much more severe occult injury could be present. MRI showed a complete rupture of the posterior ligamentous complex (PLC) along with the intervertebral disc and the posterior longitudinal ligament at T8-T9 level. The patient underwent minimally invasive posterior fixation with pedicle screws. Chance fractures of the thoracic spine are uncommon.

Conclusions: To our knowledge, this is the first report of a pure soft tissue Chance fracture located in the thoracic spine. Given that the initial CT showed no fracture evidence or vertebral malalignment, a high index of suspicion, based on the mechanism of injury, clinical examination and/or concomitant lesions, is necessary to identify such extremely unstable injury. Early recognition is crucial for appropriate therapy and to minimize the extent of neurological deficit.