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Chalk stick fracture

Case contributed by Henry Knipe
Diagnosis certain


Motor vehicle collision.

Patient Data

Age: 75 years
Gender: Male

Severely displaced fracture of the C5 vertebral body with severe distraction and posterior displacement of the superior fracture fragment relative to the inferior fracture fragment leading to severe spinal canal stenosis. Spinal cord traumatic injury is likely. 

The underlying bones are osteopenic and there is syndesmophyte formation throughout the visualized cervicothoracic spine with fusion of the facet joints, in keeping with ankylosing spondylitis.

There is elevation of the hyperdensity anterior and posterior to the spinal cord in keeping with a large epidural hematoma extending into the thoracic spine.

Extensive subcutaneous emphysema in the anterior and posterior aspects of the chest and extending upper neck.

Left apical pneumothorax. There is a right chest drain in situ and there is collapse and consolidation in the visualized right lung apex.

Case Discussion

Patients with ankylosing spondylitis, which is often undiagnosed even in elderly patients, are at high risk for severely displaced fractures due to increased stress due to decreased flexibility. 

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