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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 

Extension Fractures of the Cervical Spine

Posterior atlantoaxial subluxation

Posterior (neural) arch fracture of C1

Hangman fracture

Extension teardrop fracture



  • Neck collar
  • Restriction of activity


  • Cervical myelopathy


  • Good

Flexion Teardrop Fracture

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.
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Fracture of the Cervical Spine  eMedicine  Moira Davenport, MD; Jorma B Mueller, MD; Emilio Belaval, MD; Simon P Roy, MD