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Joseph Junewick, MD FACR
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Flexion Teardrop Fracture

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 7 years ago
Updated: over 6 years ago
Tags: PEDS
Modality/Study Types: CT MR
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Teenager with paralysis after diving accident.

Case Images


Flexion Teardrop Fracture


CT – Sagittal image shows kyphosis at C5, rotated teardrop fragment anteriorly, marked malalignment of C5 relative to C6 with severe canal compromise, and splayed interlaminar spaces. Axial image shows sagittal fracture line of the C5 vertebral body and facetal malalignment.

MR – Post-operative T1 and T2 images show multilevel cord injury.


Hyperflexion is the predominant force with hyperflexion sprain, clay shoveler fracture, simple compression fracture, bilateral interfacetal subluxation and dislocation (often with compression fracture), and hyperflexion teardrop fracture. Hyperflexion teardrop is the most severe flexion injury, resulting in disruption of anterior and posterior osseous and ligamentous support and retropulsion of the vertebral body into the spinal canal. The canal impingement produces anterior cord syndrome (immediate quadriplegia, loss of pain, temperature and sensation but preserved vibration and proprioception). This fracture needs to be distinguished from the burst fracture and hyperextension teardrop fracture. Extension of vertebral body fracture lines into the spinal canal suggest burst fracture (in contrast the spinal canal is not violated in hyperflexion teardrop – posterior displacement occurs because of PLL disruption). Hyperextension teardrop fracture can be differentiated by a neutral attitude of the spine (in contrast to kyphotic attitude with hyperflexion teardrop).


Junewick JJ. Cervical Spine Injuries in Pediatrics: Are children small adults or not? Pediatric Radiology 2010; 40(4):493-498.


Ryan Konwinski, MD

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