Flexion teardrop fracture

Case contributed by Dr Muhammad Asadullah Munir

Presentation

Road traffic accident

Patient Data

Age: 15 years
Gender: Male

Cervical spine

X-ray

Small fracture is seen along the anterosuperior aspect of C5 vertebral body with displacement of the fractured fragment anteriorly and C5 vertebral body posteriorly with mild disorientation of the facets at C5-6 level. Slightly reduced intervertebral disc space also appreciated at C5-6 level. No widening of the interspinous space is noted. There is also widening of the prevertebral space at C5-6 level.

Overall imaging appearances are representing flexion teardrop fracture with mild facet disorientation secondary to recent trauma. The position and alignment as demonstrated on plain radiograph. Further evaluation with CT / MRI cervical spine is suggested.

Cervical spine

MRI

There is loss of normal cervical lordosis, in keeping with muscular spasm with acute focal kyphosis noted at C5-6 level.

There is flexion teardrop fracture of C5 vertebral body. The fractured anterior teardrop fragment of C5 vertebral body is displaced anterosuperiorly and lying adjacent to anteroinferior corner of C5 vertebral body. The rest of the C5 vertebral body is retropulsed and causing moderately significant compression over the spinal cord. Fracture is also noted in posterosuperior corner of C6 vertebral body, which is also retropulsed and causing compression over the spinal cord.

There is long segment hyperintensity in cervical spinal cord extending from cervicomedullary junction down to C7-T1 level suggestive of cord edema, however no cord transection is present.

There is marrow edema in C4, C5, C6 and superior aspect of C7 vertebral bodies. Edema is also present in prevertebral and interspinous soft tissues extending from C1 down to C6. There is suggestion of facet subluxation at C5-6 level, however CT scan would be confirmatory.

Case Discussion

The described imaging appearances are sequelae of antecedent trauma. Flexion teardrop fracture is an unstable injury and patient needs urgent opinion from neurosurgeon / spinal orthopedics.

It results due to flexion and vertical axial compression of the spine. Such mechanical force, as sequelae of antecedent trauma, leads to a fracture of the anteroinferior aspect of the vertebral body with anterior displacement of fracture fragment which resembles a teardrop.

 

Case courtesy: Dr. Jaideep Darira (FRCR, FCPS, EDIR)

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