Spine Case #10

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.

History and PhysicalAFVSSGen: WDWN, A&Ox4HEENT: NC/AT, PERRL,

TMs intactNeck: 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.

Image

Diagnosis: Clay Shoveler’s Fracture

C6 spinous process fracture. No facet or laminar fracture seen

Lateral C-spine radiograph, or CTAnalgesicsPhiladelphia C-collar on discharge to be worn

for at least 10 daysEarly follow-up with Orthopedics, 1-2 weeksNon-operative management if fracture is

isolated and presence of instability has been ruled out

ED Management

Clay Shoveler’s Fracture is considered stableCaused by intense flexion against a

contracted posterior erector spinal muscle; MC due to deceleration MVCs

Most common at C7 > C6> T1If avulsion frx is not limited to spinous

process but extends into lamina, there is greater potential for spinal cord injury

Pearls

Additional Images

Additional Images

Illustration of Clay Shoveler’s Fx and normal vertebral anatomy

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-to-cervical-spine-c6-clay-shoveler-fracture-1

References