An 18 year old female presents to the emergency department with severe neck pain and weakness in her extremities after diving into a shallow pool while intoxicated. On examination, she has bruising on her face and tenderness in her neck with reduced strength and sensation below her arms. Radiographic images show features consistent with a teardrop fracture of her cervical spine, an unstable fracture caused by extreme neck flexion that results in spinal cord compression and requires spinal precautions, consultation, and possible admission.

2.  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. http://www.radpod.org/2007/04/27/teardrop-fracture/

4. •
Description
•
•
Mechanism
•
•
•
•
•
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
•
© 2000 by the Rector & Visitors of the University of Virginia
http://www.med-ed.virginia.edu/courses/rad/cspine
Extreme hyperflexion and vertical
axial compression forces.
Radiographic features: lateral
view
•
•
•
posterior ligament disruption and
anterior compression fracture of
the vertebral body.
unstable

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

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.