Clay Shovelers Fracture

Clay Shovelers Fracture

Clayshovelersfracturederivesitsnamefromacommon
occurrenceinclayminersinAustraliaduringthe1930s

Stableavulsionfracturethroughthespinousprocessofavertebra

Occurringatanyofthelowercervicalorupperthoracicvertebrae

ClassicallyatC6orC7
 Mechanism of Injury
It occurs with abrupt flexion of the head such as found
with motor vehicle accidents, diving, or wrestling injuries.

Occurs with repeated stress caused by the pulling of the

trapezius and rhomboid muscles.

Direct blows or trauma to the base of the neck.

 Symptoms
Suddenonsetofpainbetweentheshoulder
bladesorbaseofneck
Reducedhead/neckROM
Tenderness
 Diagnosis
Radiographs
Cervical&Thoracicx-raysthatshouldalwaysbeobtainedonevaluation
CT SCAN
Indications
RoutineCTimaginginhigh-energytraumapatients
Clinical criteria
alteredconsciousness
midlinespinalpainortenderness
impairedCCJmotion
lowercranialnerveparesis
motorparesis
 Treatment
Nonoperative
NSAIDS, rest, immobilization in hard collar for comfort
indications
mostcommontreatmentforpaincontrol
modalities
shorttermtreatmentwithhardcollar
outcomes
usuallyhighunionratesandexcellentclincaloutcomes
Operative
surgical excision
indications
Persistentpainornon-union
Failedconservativetreatment
Hangmans Fracture
 Hangmans Fracture
The second most common fracture of
the second cervical vertebra.
Involves a bilateral arch fracture of the
C2 pars interarticularis with variable
displacement of C2 on C3
 Mechanism of Injury
The injury mainly occurs from falls, usually in older adults, and
motor accidents mainly due to impacts of high force
causing Extension of the neck and great axial load onto the
C2 vertebra.

The mechanism of the injury is forcible hyperextension of the

head, usually with distraction of the neck.
 Classification

Type I: Non-displaced fractures with no

angulation between C2 and C3 and a
fracture dislocation of less than 3 mm

TypeII:significantangulation(>11)
anddisplacement(>3.5mm)
typeIIA:minimumdisplacementand
significantangulation(>11)

typeIII:severeangulationanddisplacement
andconcomitantunilateralorbilateralfacet
dislocationC23.
 Symptoms
The most common symptom of hangmans fracture is
neck pain following a fall or motor vehicle accident
The most important concern with hangmans fracture is
injury to the spinal cord.
If the spinal cord is damaged, symptoms can include
pain, sensory loss, weakness, paralysis, and/or death.
 Tests and Diagnosis
X-ray - flexion and extension radiographs show subluxation

Computed tomography scan (CT scan) -

study of choice to delineate fracture pattern

Magnetic resonance imaging (MRI) - consider if suspicious of a

vascular injury to the vertebral artery
 Treatment
Nonoperative

Rigid cervical collar x 4-6 weeks

Indications :Type I fracture
 Closed reduction followed by halo immobilization for 8-
12 weeks
Indications
Type II with 3-5 mm displacement
Type IIA
Reduction technique
Type II use axial traction combined + extension
Type IIA use hyperextension (avoid axial traction in Type IIA)
Operative
Reduction with surgical stabilization
Indications
Type II with > 5 mm displacement and severe angulation
Type III (facet dislocations)
Technique
anterior C2-3 interbody fusion
posterior C1-3 fusion
bilateral C2 pars screw osteosynthesis
Odontoid Fracture
 Odontoid Fracture

The most common axis injury is a fracture through the

odontoid process.
Translational motion of C1 on C2 is restricted by the
transverse atlantal ligaments that center the odontoid
process to the anterior arch of C1.
With a fracture of the odontoid process, restriction of
translational atlantoaxial movement is lost.
 Mechanism of Injury
Flexion loading is the cause in the majority of patients, and
results in anterior displacement of the dens

Extension loading (forward fall onto forehead) occurs in a

minority of patients, and results in posterior displacement of
the dens;
 Classification
AccordingtotheclassificationofAndersonandDAlonzo:

Type I: oblique fractures through

the upper portion of the odontoid
process.
Type II: across the base of the
odontoid process at the
junction with the axis body.
 Type III: through the odontoid
that extends into the C2 body.
 Treatment
A variety of non-operative and operative treatment
alternatives have been proposed for odontoid fractures
based on:
fracture type
degree of (initial) dens displacement
extent of angulation
patients age
Type II and Type III odontoid fractures should be considered for
surgical fixation in cases of:

dens displacement of 5 mm or more

inability to achieve fracture reduction
inability to achieve main fracture reduction with external
immobilization
 Anterior trans articular screw fixation: As an augmentation of
the anterior dens screw or in cases of a salvage procedure.
Screws can be inserted over Kirschner wires from a medial-
anterior-caudal to a lateral-posterior-cranial direction crossing
the atlantoaxial joint.