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Joseph Junewick, MD FACR
over 7 years ago
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Ring Apophyseal Avulsion Fracture

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 9 years ago
Updated: over 9 years ago
Tags: PEDS
Modality/Study Types: CR MR
Adobe32 PDF Imagej32 ImageJA


High school football player with neck injury.

Case Images


Ring Apophyseal Avulsion Fracture


CR – The inferior ring apophysis of C3 is anteriorly displaced and associated with prevertebral soft tissue swelling.

MR – Sagittal IR shows subtle edema of the anterior inferior corner of the C3 vertebral body, anterior displacement of the inferior ring apophysis, and prevertebral edema.


Avulsion of the superior or inferior ring apophyses of the cervical spine is an uncommon injury in adolescents and young adults. Superior apophysis avulsion occurs after flexion, whereas inferior ring apophysis avulsion occurs with extension; both are related to disruption of Sharpey’s fibers. The follow-up appearance is characteristic in both instances. With superior ring apophysis avulsion, there is a bow shape of the superior aspect of the vertebral body. With inferior avulsion, the avulsed apophysis fuses with the vertebral body and forms a spur, whose shape and size depend on the degree of displacement. Ring apophyseal avulsion injuries can occur anywhere along the ring but are most common anteriorly and posteriorly.


Jonsson K, Niklasson J, Josefsson O. Avulsion of the cervical spinal ring apophyses: acute and chronic appearance. Skeletal Radiol (1991); 20(3):207-210.

Edeiken-Monroe B, Wagner LK, Harris JH. Hyperextension dislocation of the cervical spine. AJR (1986); 146:803-808.

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