Jefferson fracture with extension teardrop fracture

Case contributed by Maxime St-Amant
Diagnosis certain


? Fracture.

Patient Data

Age: 55 years
Gender: Female

There is a fracture of the anteroinferior 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 confirm 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

Surprisingly (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 anteroinferior fractures 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 :


  • Vertical diameter of the fragment > or = to its horizontal diameter
  • Angle of 35° with the vertebral endplate


  • 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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