A 43 yo intoxicated male presents after he was struck by a vehicle while riding a bicycle.  Bystanders reported to EMS that there was no LOC and that patient ambulated at the scene.  History limited from patient secondary to intoxication.  Multiple cat scans ordered due to limited history / intoxication.  What's the diagnosis?  Scroll down for answer.

Answer:  C2 teardrop fracture

• Mechanism: extreme hyperflexion, usually high energy trauma (MVA, fall from height)
• Wedge-shaped fracture of anterior inferior portion of vertebral body
• Considered highly unstable, anterior and posterior ligaments can be disrupted
• Symptoms: pain, sensory and/or motor deficits concerning for spinal cord injury, burning sensations upper extremities
• CT cervical spine w/o contrast, consider CTA of neck if concern for vessel injury, MRI for ligamentous evaluation
• Maintain cervical spine precautions, cervical collar, consult spine surgery - management based on injury classifcation and nurological status (rigid collar vs fusion)

References

Go S. Spine Trauma. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016.

Watanabe M, Daisuke S, Yukihiro Y, Masato S, Joji M. "Clinical features of the extension teardrop fracture of the axis: review of 13 cases". Journal of Neurosurgery: Spine SPI 14.6: 710-714. < https://doi.org/10.3171/2011.1.SPINE10687 >