Flexion teardrop fracture (x-ray)
Diving injury in the surf. Neck pain.
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C4 vertebral body fracture with a large anteroinferior corner teardrop fragment displaced anteriorly with associated prevertebral soft tissue swelling. Straightening of the normal cervical lordosis with an acute angle kyphosis at the C4 level and some mild retropulsion. The C4/5 facet joints and interspinous space are widening considerably indicating posterior ligamentous injury.
This represents a 3-column unstable injury and needs spinal precautions (if not already) and CT and MRI assessment.
Flexion teardrop fractures are associated with posterior element injury and hence a higher risk of cord injury than extension teardrop fractures. The spinal canal and cord need to be assessed with MRI as these injuries can be occult on X-ray and CT.