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Clay Shoveler's Fracture
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Clay Shoveler's Fracture

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  • 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. C6 spinous process fracture. No facet or laminar fracture seen
  • 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.  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. Illustration of Clay Shoveler’s Fx and normal vertebral anatomy
  • 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