An extension teardrop fracture is caused by the traction of the anterior longitudinal ligament, the fibers of which insert into the inferior portion of the anterior cortex of the vertebral body. 

C2 is the most common level for an extension teardrop. It is characterized by a small triangular-shaped fracture fragment from the anteroinferior corner of a vertebral body. The middle and posterior columns are intact and with a variable degree of prevertebral soft tissue swelling. 

Extension teardrop is not considered as severe as flexion teardrop fractures and it does not typically produce direct neurologic injury.

Case co-author: Rehana Jaffer, MD, FRCPC