Jefferson fracture with extension teardrop

Case contributed by Dr Maxime St-Amant

Presentation

R/o fracture.

Patient Data

Age: 55
Gender: Female

There is a fracture of the antero-inferior vertebral body of C3. There also is a highly probable Jefferson fracture: the lateral masses of C1 are too far apart (odontoid view) dans there are radiolucent lines in projection of the posterior and anterior aspect of C1's arch.

CT-scans confirms the suspicions findings on plain film.

1) Jefferson fracture

2) Extension teardrop fracture

3) Left occipital condyle fracture

4) Posterior arch of the first rib probable fracture

Case Discussion

Suprisingly (or not) there is no prevertebral soft tissue swelling. It is a highly non specific finding found a lot more with flexion teardrop extension. Flexion & extension teardrop are both antero-inferiorfractures of the vertebral body. Flexion teardrop is considered one of the most unstable cervical fracture.

Apart from the trauma mechanism, flexion & extension teardrop can be distinguished :

Extension

-Vertical diameter of the fragment > or = to its horizontal diameter

 -Angle of 35° with the vertebral endplate

Flexion

-Associated with interspinal ligaments rupture (widening of the posterior elements)

-Loss of height of the anterior vertebral body

-Facets subluxation

Extension teardrop is treated conservatively with immobilization (C spine collar). Flexion teardrop is treated surgically  

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Case information

rID: 19122
Case created: 8th Aug 2012
Last edited: 6th Nov 2016
Inclusion in quiz mode: Included

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