Extension teardrop fracture

Extension teardrop fracture typically occurs due to forced extension of the neck with resulting avulsion of the anteroinferior corner of the vertebral body. Extension teardrop fractures are stable in flexion and unstable in extension as the anterior longitudinal ligament is disrupted. Extension teardrop is not considered as severe as flexion teardrop fractures.

Pathology

They occur due to forced extension of the neck (i.e. is a hyperextension injury) with resulting avulsion of the anteroinferior corner of the vertebral body.

In older patients, the C2 vertebral body is commonly affected due to degenerative ankylosis of lower levels. Associated cervical spine fractures are common. 

Associations

• central cord syndrome: acute traumatic central cord syndrome

Radiographic features

• anterior-inferior corner fracture ³
  • avulsion fracture from the attachment of the anterior longitudinal ligament to the inferior corner of the vertebral body, usually a thin fracture fragment
  • the fragment is triangular in a shape reminiscent of a teardrop
  • vertical height of fragment is equal to or greater than width
  • anterior disc space widening

Practical points

• additional fractures are common and thus, CT scan is indicated in all cases

See also

• teardrop (disambiguation)