Spine Flexion Teardrop Fracture

1. Spine Case # 2

2. History and Physical 18 yo female presents to ED w/ severe midline cervical pain after diving into the shallow end of a pool. Pt appears intoxicated and friends report pt had been partying celebrating recent graduation from high school. Denies LOC. Unable to ambulate on scene. Complains of upper & lower extremity weakness. T 99.2 P 87 BP 132/78 O2 98% RA RR 18 Gen: WDWN, mild distress HEENT: bruising to face, PERRL, EOMI Back: severe midline cervical tenderness with edema, no step offs Neuro : 3/5 strength throughout, loss of sensation to pain, temperature, and touch distal to mid-arms

3. C-spine radiographs http://www.radpod.org/2007/04/27/teardrop-fracture/

4. Diagnosis: Flexion teardrop fracture Description posterior ligament disruption and anterior compression fracture of the vertebral body. Mechanism Extreme hyperflexion and vertical axial compression forces. Radiographic features : lateral view Prevertebral swelling Teardrop fragment from anterior vertebral body avulsion fracture. Posterior vertebral body subluxation into the spinal canal. Spinal cord compression from vertebral body displacement. Fracture of the spinous process. Stability unstable © 2000 by the Rector & Visitors of the University of Virginia http://www.med-ed.virginia.edu/courses/rad/cspine

5. Maintain c-spine precautions Consult Spine Consider steroids in conjunction with Spine Admit ED Management

6. Most severe fracture of cervical spine Unstable Assoc. w/ acute anterior cord syndrome Most commonly occurs at C5-C6 in adults On x-rays the facet joints and interspinous distances are usually widened and the disk space may be narrowed 70% of patients can have neurologic deficit http://www.wheelessonline.com/ortho/flexion_tear_drop_fracture http://www.radiologyassistant.nl/en/49021535146c5#a4904c011b0177 n of ligaments and anterior cord syndrome. Clinical Pearls