Hosting 718 files, 2916 images, and 4 contributors.

 
Random Case

UVC Related Hepatic Injury
Joseph Junewick, MD FACR
over 8 years ago
Enter A Workflow
Standard2   Academic2

Please choose a workflow. A standard workflow allows you to browse the repository with full case detail; the academic workflow allows you to browse the repository with limited case detail revealed. Double click on the images to launch image viewer.

ARSt Case Repository

Flexion Teardrop Fracture

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 3 years ago
Updated: over 3 years ago
Tags: PEDS
Modality/Study Types: MR CT
Activities:
Adobe32 PDF Imagej32 ImageJA

History

Teenager with paralysis after diving accident.


Case Images


Diagnosis

Flexion Teardrop Fracture

Findings

CT – Sagittal image shows kyphosis at C5, rotated teardrop fragment anteriorly, marked malalignment of C5 relative to C6 with severe canal compromise, and splayed interlaminar spaces. Axial image shows sagittal fracture line of the C5 vertebral body and facetal malalignment.

MR – Post-operative T1 and T2 images show multilevel cord injury.

Discussion

Hyperflexion is the predominant force with hyperflexion sprain, clay shoveler fracture, simple compression fracture, bilateral interfacetal subluxation and dislocation (often with compression fracture), and hyperflexion teardrop fracture. Hyperflexion teardrop is the most severe flexion injury, resulting in disruption of anterior and posterior osseous and ligamentous support and retropulsion of the vertebral body into the spinal canal. The canal impingement produces anterior cord syndrome (immediate quadriplegia, loss of pain, temperature and sensation but preserved vibration and proprioception). This fracture needs to be distinguished from the burst fracture and hyperextension teardrop fracture. Extension of vertebral body fracture lines into the spinal canal suggest burst fracture (in contrast the spinal canal is not violated in hyperflexion teardrop – posterior displacement occurs because of PLL disruption). Hyperextension teardrop fracture can be differentiated by a neutral attitude of the spine (in contrast to kyphotic attitude with hyperflexion teardrop).

Reference

Junewick JJ. Cervical Spine Injuries in Pediatrics: Are children small adults or not? Pediatric Radiology 2010; 40(4):493-498.

Contributor

Ryan Konwinski, MD



Corporate Office: 616.363.7272, 3264 North Evergreen Drive, Grand Rapids, MI 49525

Spectrum Health Helen Devos Childrens Hospital GE HealthCare