Flexion teardrop fracture of C2

Case contributed by Dr Bruno Di Muzio

Presentation

Fall backwards from 4 meters.

Patient Data

Age: 50 years
Gender: Female
CT

CT Cervical Spine and CTA Neck and Brain

Unstable flexion teardrop fracture of C2 is noted involving the anterior inferior body and both pedicles extending through the foramen transversarium bilaterally. This pushes the C2 vertebral body and consequently the atlas anteriorly. Nondisplaced fracture of the anterior arch of C1 is noted. There is no significant anterior displacement of C2 on C3 noted. There is a posterosuperior corner injury of the C3 vertebral body and this extends towards but not into the left C3 pedicle. Throughout the remainder of the C-spine, no further fracture is identified. There is prevertebral soft tissue swelling noted. 

No facial bone or intracranial injury (images not shown).

The left vertebral artery is congenitally hypoplastic and arises directly from the arch, terminating in PICA. The right vertebral artery is a large calibre vessel. There is no vertebral artery stenosis or dissection identified. The basilar artery and posterior cerebral arteries appear unremarkable. The common and internal carotid arteries appear unremarkable. The anterior and middle cerebral arteries are patent as are the branch vessels. No aneurysm, AV malformation or dural fistula is identified. The soft tissues of the neck demonstrate anterior stranding. 

Annotated image

The mechanism of the trauma caused a combination of flexion and compression leading to a teardrop fragment at the anteroinferior corner of C2 (arrow), bilateral C2 lateral mass fractures, and a consequent tilt of C2/dens and anterior displacement of C1 with a mild widening of the C1/2 interspinous distance (star). 

Case Discussion

The mechanism of the trauma caused a combination of flexion and compression leading to a teardrop fragment at the anteroinferior corner of C2, bilateral C2 lateral mass fractures, and a consequent tilt of C2/dens and anterior displacement of C1 with a mild widening of the C1/2 interspinous distance. 

Although this case shows features of a flexon injury at C2, the flexion teardrop fractures of the cervical spine are known to commonly affect the lower levels (C5 and C6 vertebral bodies), with the extension teardrop fractures commonly affecting C2. 

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Case information

rID: 56882
Case created: 26th Nov 2017
Last edited: 3rd Dec 2017
Inclusion in quiz mode: Included

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