A 17-year-old male was involved in a head-on motor vehicle collision at 35-40 mph and presented with cervical neck pain but was ambulatory and alert. Imaging revealed a C6 spinous process fracture, known as a Clay Shoveler's fracture, which is considered stable and results from flexion against contracted neck muscles during deceleration. The patient was placed in a Philadelphia collar and advised to follow-up with orthopedics in 1-2 weeks for non-operative management given the isolated nature of the fracture.

2.  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.

4. C6 spinous process fracture. No facet or laminar fracture seen

5.  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

6.  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

8. Illustration of Clay Shoveler’s Fx
and normal vertebral anatomy

9.  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