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Extension Teardrop Fracture of Cervical Spine
General Considerations
- Fracture of the cervical spine caused by the sudden pull of the anterior longitudinal ligament on the anterior, inferior aspect of the vertebral body following extreme hyperextension of the neck
- Usually involves C2
- Anterior longitudinal ligament inserts on anteroinferior aspect of C2
- Fracture of C2 is stable in flexion and unstable in hyperextension
Clinical Findings
- Neck pain
- Tenderness to palpation, especially posteriorly
- Limited range of motion
Imaging Findings
- As a screen, the lateral radiograph of the cervical spine will demonstrate 85-90% of cervical spine injuries
- All 7 vertebral bodies should ideally be demonstrated
- CT has replaced conventional radiography in many cases and should be done if the conventional radiographs are normal but there is a high suspicion of cervical spine injury
- Triangular avulsion of the anteroinferior aspect, usually of C2
- No loss of stature of the vertebral body
- Vertical height of the fracture is greater than its width
- Prevertebral soft tissue swelling
- As a rule of thumb, the soft tissue anterior to C3 should be less than 1/2 of the AP diameter of C3 and the soft tissue anterior to C6 should be less than 2/3 of the AP diameter of C6
Differential Diagnosis
- Flexion teardrop fracture also involves anteroinferior aspect of vertebral body
- Unlike extension injury, this is not an avulsion fracture but an injury caused by compression of the anterior aspect of the vertebral body
- Associated with severe ligamentous injury and loss of stature of the anterior aspect of the vertebral body
- Serious fracture
- Occurs at lower cervical levels
- Unstable and frequently associated with spinal cord injuries
Treatment
- Neck collar
- Restriction of activity
Complications
Prognosis
Extension Teardrop Fracture of the Cervical Spine. Lateral radiograph of the cervical spine shows a small triangular fragment of bone avulsed from the anterior, inferior border of C3 (white arrow). There is no associated Hangman's fracture.
For this same photo without the arrows, click here
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Fracture of the Cervical Spine eMedicine Moira Davenport, MD; Jorma B Mueller, MD; Emilio Belaval, MD; Simon P Roy, MD
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