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Flexion Tear Drop Fracture

- See: Lower Cervical Burst Frx:

- Discussion:
    - most severe fracture of cervical spine
    - results from combination of extreme flexion & compressive forces
    - commonly results from a dive into a shallow pool of water;
    - associated w/ acute anterior cervical cord syndrome
    - quadriplegia, loss of sensations of pain, temp, and touch;
    - in adult, this frx occurs most commonly at C5-C6
    - frx is unstable as result of complete disruption of both ligamentous and bony structures;
    - type of flexion instability w/ failure of anterior column and/or anterior & middle columns, w/ concomitant disruption of posterior 
          ligamentous complex;
    - anterior column failure:
          - when just the anterior column fails, the anterior vertebral body frx & posterior longitudinal ligaments fail;
                 - in this fracture the middle column is intact and neurologic injuries are less common;
    - middle column failure:
          - tear drop fracture dislocation involves major compression forces;
          - w/ failure of middle column, there can be retropulsion of bone into the spinal canal (burst frx);
                 - there is higher incidence of neurologic injury w/ middle column failure;
          - tear drop may either involve an anteroinferior body fragment, or a posterior inferior fragment;
                 - the postero-inferior fragment may encroach into the canal and cause paralysis;

- Fracture Characteristics:
    - kyphosis at the level of injury
           - kyphosis w/ posterior displacement of the spine above the level of the frx, and widening or "fanning" of posterior ligamentous 
    - vertebral body frx: - triangular frag off the anteroinferior body
    - narrowing of the disc space
    - widening of the interspinous and interlaminar spaces
    - anterior dislocation / subluxation of articular fascets;
    - posterior displacement of the involved vertebral bony fragments w/ varying degrees of compromise of AP diameter of the canal;
    - burst frx & hyperextension teardrop frx are associatted;
    - on CT scan a characteristic finding of flexion tear drop fractures is saggital fracture through the vertebral body


The axial load teardrop fracture. A biomechanical, clinical and roentgenographic analysis.