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Cervical Teardrop Fracture

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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


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


References


  1. 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
  2. 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.
  3. 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.
Created by:
John Kiel on 4 July 2019 09:28:36
Authors:
Last edited:
17 November 2020 15:46:06
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