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Cervical Teardrop Fracture
From WikiSM
(Redirected from Cervical Burst Fracture)
Contents
Other Names
- Teardrop fracture
- Extension teardrop fracture (ETF)
- Flexion teardrop fracture (FTF)
- Quadrangular fracture
Background
- This page describes triangular fracture fragments of the Vertebral Body, commonly referred to as teardrop fractures
- Flexion teardrop fracture (FTF): this is considered an unstable fracture (more severe)
- Extension teardrop fracture (ETF): this is considered an stable fracture (less severe)
History
- First described by Kahn and Schneider in 1956[1]
Epidemiology
- Both ETF and FTF are rare and not well documented in the literature
- ETF estimated to 11-15% of upper cervical spine fractures[2]
Pathophysiology
- General
- Typically, anteroinferior corner of vertebral body
- Flexion: Most commonly due to flexion with axial load
- Anterior column fails in flexion with compression
- Subsequently, retropulsion of vertebral body segment
- Most commonly occur at mid or lower cervical spine C4, C5, C6[3]
- Extension: Less comonly due to extension with axial load
- Commonly C2 vertebral body in older patients
- Stable in flexion, unstable in extension
Etiology
- Flexion injuries classically occur due to severe flexion with axial compression load
- Diving impact, deceleration during MVC
- Extension injuries
Pathoanatomy
- Anterior Longitudinal Ligament (ALL)
- In ETF, ALL is disrupted avulsing off anteroinferior fragment
Associated Injuries
- Spinal Cord Injury
- Cervical Spine Fractures
- Central Cord Syndrome
Risk Factors
Differential Diagnosis
- Fractures
- Subluxations and Dislocations
- Neuropathic
- Muscle and Tendon
- Pediatric/ Congenital
- Other Etiologies
Clinical Features
- General: Physical Exam Neck
- History
- Need to characterize mechanism of trauma
- Patient will complain of neck pain
- Physical Exam
- ETF: Patients typically neurologically intact
Evaluation
Radiographs
- Begin with standard 3 view cervical spine
- Flexion Teardrop Fracture Findings
- Fracture of the anteroinferior lip of vertebral body (triangular fragment or 'teardrop')
- Posterior displacement of the posterior vertebral body
- Extension Teardrop Fracture findings
- Avulsion fracture due to ALL
- Anterior disc space widening
CT
- Indicated in all cases of fractures on standard radiographs
- Also indicated in all high energy trauma
MRI
- Can be useful to help distinguish flexion type injury
- Evaluate integrity of posterior longitudinal ligament (PLL)
- Evaluate other soft tissue injuries
Classification
- N/A
Management
Prognosis
- Needs to be updated
Nonoperative
- FTF
- Indications: few
- immobilized in hard Cervical Collar for 6-12 weeks or external halo
- ETF
- Indications: Virtually all cases
- Need to be immobilized in hard Cervical Collar for 6-12 weeks
Operative
- FTF
- Indications: most
- Technique: anterior or posterior decompression, corpectomy and fusion
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play
- Needs to be updated
Complications
- Spinal Cord Injury
- Cervical Spine Fractures
- Central Cord Syndrome
- Persistent Pain
- Nonunion
See Also
- Internal
- External
- Sports Medicine Review Neck Pain: https://www.sportsmedreview.com/by-joint/neck/
References
- ↑ Kahn EA, Schneider RC: Chronic neurological sequelae of acute trauma to the spine and spinal cord. I. The significance of the acute-flexion or tear-drop fracture-dislocation of the cervical spine. J Bone Joint Surg Am 38-A:985–997, 1956
- ↑ Watanabe, Masahiko, et al. "Clinical features of the extension teardrop fracture of the axis: review of 13 cases." Journal of Neurosurgery: Spine 14.6 (2011): 710-714.
- ↑ Kim KS, Chen HH, Russell EJ et-al. Flexion teardrop fracture of the cervical spine: radiographic characteristics. AJR Am J Roentgenol. 1989;152 (2): 319-26.