Extension teardrop, odontoid and Chance fractures

Case contributed by Dr Heather Pascoe


Passenger in high speed MVA

Patient Data

Age: 85 years
Gender: Female

Brain and Cervical spine


  • Large frontal subgaleal hematoma. 
  • Small amount of subarachnoid hemorrhage at the vertex and in the interhemispheric fissure.
  • No calvarial fracture.
  • Fracture and slight displacement of the nasal bone and nasal septum. Mixed gas/fluid soft tissue swelling of the nasal cavity.


  • Undisplaced type II odontoid fracture.
  • Hyperextension teardrop fracture of anterior aspect of the inferior C3 endplate.

Chest, Abdomen and Pelvis


  • Slightly displaced right posterior first rib fracture with an adjacent small extra pleural hematoma. This is away from the right subclavian vessels which enhance normally.
  • Right 3rd-7th rib fractures laterally (3rd - 5th are 'flail segments’).
  • Right extrapleural gas (+/- tiny right pneumothorax).
  • Tiny left pneumothorax.

Thoracic spine

  • Unstable 3 column fracture through the T9 vertebral body (Chance fracture). Surrounding hematoma.
  • Left T1 transverse process fracture.


  • Slit like IVC – hypovolemia.

Incidental findings

  • Right lung calcified granulomas.
  • Small hiatus hernia.


  • Severely comminuted fracture through the proximal tibia involving both lateral and medial articular surfaces with up to a 3.2 cm gap at the lateral tibial plateau.  The fracture line extends to the proximal tibiofibular joint.
  • Comminuted fracture of the fibular neck and likely minimally displaced fracture through the fabella.
  • Moderate lipohemarthrosis.
  • Surrounding soft tissue edema/hematoma with a few foci of active bleeding in the prepatellar soft tissues.

Case Discussion

Fractures of the odontoid are classified into 3 types. Type II fractures, as seen in this case, are the most common. They can be subtle on axial images and are often better visualized on sagittal reformats. 

In both flexion and extension teardrop fractures, the teardrop fragment comes from the anteroinferior aspect of the vertebral body. However, in the flexion type, there is posterior displacement of the larger part of the vertebral body which can result in spinal cord injury. In extension tear drop fractures, the neck is stable when flexed but unstable in extension. However, in young patients, a high degree of trauma is required to produce this injury and hence spinal cord injury is common.

Chance fractures are most common from T11-L3 as they most often occur due to a seatbelt injury. 

Fractures of the 1st-3rd ribs indicates high energy trauma because a significant amount of force is required to fracture them. 


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Case information

rID: 32898
Published: 12th Feb 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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