 17 yo male restrained

driver presents packaged
by EMS, involved in car vs
tree, head-on MVC at
approx 35-40 mph. No
LOC...
C6 spinous process fracture. No facet or laminar fracture seen
 Lateral C-spine radiograph, or CT
 Analgesics
 Philadelphia C-collar on discharge to be worn for at

least 10 days
 E...
 Clay Shoveler’s Fracture is considered stable
 Caused by intense flexion against a contracted

posterior erector spinal...
Illustration of Clay Shoveler’s Fx
and normal vertebral anatomy
 Schwartz DT: Emergency Radiology: Case Studies:

http://www.accessemergencymedicine.com
 Simon RR, Sherman SC: Emergenc...
Clay Shoveler's Fracture
Clay Shoveler's Fracture
Clay Shoveler's Fracture
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Clay Shoveler's Fracture

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Clay Shoveler's Fracture

  1. 1.  17 yo male restrained driver presents packaged by EMS, involved in car vs tree, head-on MVC at approx 35-40 mph. No LOC, no airbag deployment, broken windshield. Pt did ambulate on scene. C/o cervical neck pain.  AFVSS  Gen: WDWN, A&Ox4  HEENT: NC/AT, PERRL, TMs intact  Neck: C6-C7 CMT without step-offs, trachea midline.  Neuro: CNs 2-12 intact, Nml 5/5 motor strength and sensation x 4. Nml reflexes.  MSK: No thoracic/lumbar TTP/step-offs. No gross signs of trauma. Long bones and joints palpated without tenderness or instability.
  2. 2. C6 spinous process fracture. No facet or laminar fracture seen
  3. 3.  Lateral C-spine radiograph, or CT  Analgesics  Philadelphia C-collar on discharge to be worn for at least 10 days  Early follow-up with Orthopedics, 1-2 weeks  Non-operative management if fracture is isolated and presence of instability has been ruled out
  4. 4.  Clay Shoveler’s Fracture is considered stable  Caused by intense flexion against a contracted posterior erector spinal muscle; MC due to deceleration MVCs  Most common at C7 > C6> T1  If avulsion frx is not limited to spinous process but extends into lamina, there is greater potential for spinal cord injury
  5. 5. Illustration of Clay Shoveler’s Fx and normal vertebral anatomy
  6. 6.  Schwartz DT: Emergency Radiology: Case Studies: http://www.accessemergencymedicine.com  Simon RR, Sherman SC: Emergency Orthopedics, 6th ed. Chapter 9: Cervical Spine Trauma. www.accessemergencymedicine.com  Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7th ed. Chapter 255: Spine and Spinal Cord Trauma  http://radiopaedia.org/cases/barbell-injury-tocervical-spine-c6-clay-shoveler-fracture-1

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