C3-C7 fractures Lin M and Mahadevan S. “Spine and Spinal Cord Injuries” in Adams J et al (eds),

Emergency Medicine. New York: Elsevier, 2007.

Injury (mech) Stable Comment Articular mass fx (flex-rotation)

Yes * Associated with transverse process and vertebral body fractures

* Uncommon Burst fx (axial compress’n)

Yes/ No

* Compressive fracture of the anterior and posterior vertebral body

* Complication: spinal cord injury because of retropulsed vertebral body fragment (especially anterior cord syndrome)

Spinous process fx (flexion)

Yes * A.K.A “Clay Shoveler’s Fracture” * Spinous process fracture from forceful neck flexion * Most commonly occurs in lower cervical levels (C7) * Not associated with neurologic injury

Extension teardrop fx (extension)

No * See C1 and C2 fracture PV card * Most commonly occurs at C2

Facet dislocation, bilateral (flexion)

No * Significant anterior displacement (>50%) of spine when bilateral inferior facets displace anterior to the superior facets below

* At risk for injuring anterior and posterior longitudinal ligament, disk, vertebral arteries, and spinal cord

Facet dislocation, unilateral (flex-rotation)

Yes * Usually causes 25-50% anterior displacement of spine

* Complication: vertebral artery injury (CT angiography recommended)

Flexion teardrop fx (flexion and axial load)

No * Fracture and anterior displacement of anteroinferior vertebral body (appears similar to extension teardrop fracture, except much more unstable)

* Rupture of both ant & post ligamentous complexes * Unique findings for flexion (versus extension)

teardrop fx: Same-level fxs, displacement of posterior structures

* Regarded as one of the most unstable fx in the lower cervical spine, because involves both columns

* Usually occurs at C5 or C6 Subluxat’n, anterior (flexion)

No * Ruptured posterior ligamentous complex, such that anterior and posterior vertebral lines are disrupted

* Complication: vertebral A. dissection (CT angio rec) * May only be evident during flexion views by

conventional xray --> the interspinous distance widens and the vertebral body subluxes anteriorly

Transverse process fx (lateral flexion)

Yes * Complication: vertebral A. injury, because travels within the transverse foramina (CT angio rec)

* Complication: Cervical radiculopathy and brachial plexus injuries associated in 10% of cases

Wedge fx (flexion)

Yes * Compression fracture of only the anterosuperior vertebral body endplate

* Disruption of anterior vertebral line