Jefferson fracture with extension teardrop fracture

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 :

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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