short note presentation prepared for morning session of my university

1. Welcome to My ShortnoteWelcome to My Shortnote
PresentationPresentation

2. Clay Shoveller’s FractureClay Shoveller’s Fracture
Dr. Md. Monirul IslamDr. Md. Monirul Islam
MS Resident , Phase –BMS Resident , Phase –B
Dept. Of OrthopaedicsDept. Of Orthopaedics
BSMMUBSMMU

3. DefinitionDefinition
Clay-shoveller's fractureClay-shoveller's fracture is a fractureis a fracture
through the spinous process of a vertebrathrough the spinous process of a vertebra
occurring at any of the lower cervical oroccurring at any of the lower cervical or
upper thoracic vertebrae, classically atupper thoracic vertebrae, classically at C6C6
oror C7C7

4. Clay Shoveller’s FractureClay Shoveller’s Fracture

5. Clay Shoveller’s FractureClay Shoveller’s Fracture

6. Clay Shoveller’s FractureClay Shoveller’s Fracture

7. HistoryHistory
In Australia in the 1930s, men digging deepIn Australia in the 1930s, men digging deep
ditches tossed clay 10 to 15 feet above theirditches tossed clay 10 to 15 feet above their
heads using long handled shovels. Insteadheads using long handled shovels. Instead
of separating, the sticky clay wouldof separating, the sticky clay would
sometimes stick to the shovel; the workersometimes stick to the shovel; the worker
would hear a pop and feel a sudden painwould hear a pop and feel a sudden pain
between the shoulder blades, unable tobetween the shoulder blades, unable to
continue workingcontinue working

8.  Why clay rather than dirt or sand? TheWhy clay rather than dirt or sand? The
reason is due to the stickiness of clay. As areason is due to the stickiness of clay. As a
clay shovellers tossed the shovel upward,clay shovellers tossed the shovel upward,
the clay sometimes stuck to it whichthe clay sometimes stuck to it which
produced a sudden flexion force on the neckproduced a sudden flexion force on the neck
and back muscles, resulting in the fracture.and back muscles, resulting in the fracture.

9. Mechanism of InjuryMechanism of Injury
 The mechanism of injury is believed to beThe mechanism of injury is believed to be
secondary to muscle pull and reflex withsecondary to muscle pull and reflex with
force transmission through the supraspinousforce transmission through the supraspinous
ligaments. The tremendous force pulls onligaments. The tremendous force pulls on
the spinous process producing an avulsionthe spinous process producing an avulsion
fracturefracture
 The shear force of the muscles (trapeziusThe shear force of the muscles (trapezius
and rhomboid muscles) pulling on the spineand rhomboid muscles) pulling on the spine
at the base of the neck actually tears off theat the base of the neck actually tears off the
bone of the spinebone of the spine

10.  Clay-shoveller's fracture usually occurs inClay-shoveller's fracture usually occurs in
labourers who perform activities involvinglabourers who perform activities involving
lifting weights rapidly with the armslifting weights rapidly with the arms
extended.extended.
 Examples of these activities includeExamples of these activities include
shovelling soil, rubble or snow up and overshovelling soil, rubble or snow up and over
the head backwards, using a pickax orthe head backwards, using a pickax or
scythe, and pulling out roots.scythe, and pulling out roots.

12.  as a direct blow to the posterior aspect ofas a direct blow to the posterior aspect of
the neck, cervical hyperextension andthe neck, cervical hyperextension and
hyperflexion injuries and muscle andhyperflexion injuries and muscle and
ligament stresses, generally due to shovelligament stresses, generally due to shovel
heavy loadsheavy loads

13. Clinical featureClinical feature
 Symptoms include :Symptoms include :
-Burning, "knife-like" pain at the level of the-Burning, "knife-like" pain at the level of the
fractured spine between the upper shoulderfractured spine between the upper shoulder
blades.blades.
-The pain can sharply increase with repeated-The pain can sharply increase with repeated
activity that strains the muscles of the upperactivity that strains the muscles of the upper
back.back.
-The broken spine and nearby muscles are-The broken spine and nearby muscles are
exquisitely tender.exquisitely tender.

14. DiagnosisDiagnosis
 History : Typical Mechanism of injury withHistory : Typical Mechanism of injury with
significant clinical Features indicadingsignificant clinical Features indicading
High Clinical SuspisionHigh Clinical Suspision
 Investigations :Investigations :
1. Xray Cervical Spine Lateral View1. Xray Cervical Spine Lateral View
2. CT Scan of Cervical Spine2. CT Scan of Cervical Spine

15. ManagementManagement
 Most patients require no treatment. PainMost patients require no treatment. Pain
medications, physical therapy, and massagemedications, physical therapy, and massage
can be of help. Occasionally, surgicalcan be of help. Occasionally, surgical
removal of the tip of the broken spine isremoval of the tip of the broken spine is
performed for those with longstanding pain.performed for those with longstanding pain.

16.  While the intense pain gradually subsides inWhile the intense pain gradually subsides in
days to weeks, the area can intermittentlydays to weeks, the area can intermittently
develop burning pain with certain activitiesdevelop burning pain with certain activities
that involve prolonged extending of thethat involve prolonged extending of the
arms (like computer work).arms (like computer work).

17. PearlsPearls
 Clay Shoveler’s Fracture is consideredClay Shoveler’s Fracture is considered
stablestable
 Caused by intense flexion against aCaused by intense flexion against a
contracted posterior erector spinal musclecontracted posterior erector spinal muscle
 Most common at C7 > C6> T1Most common at C7 > C6> T1
 If avulsion frx is not limited to spinousIf avulsion frx is not limited to spinous
process but extends into lamina, there isprocess but extends into lamina, there is
greater potential for spinal cord injurygreater potential for spinal cord injury

18. SumarrySumarry
Lateral C-spine radiograph, or CT
Analgesics
Philadelphia C-collar on discharge to be worn
for at least 10 days
Early follow-up after 1-2 weeks
Non-operative management if fracture is
isolated and presence of instability has been
ruled out

19. THANK YOUTHANK YOU