Teardrop fractures

Types

 

Flexion-Distraction / Teardrop

Extension-Distraction / Teardrop

 

Flexion-Distraction / Teardrop

 

Mechanism

 

Severe axial / hyper-flexion injury

- diving into swimming

- 3 column injury

- high incidence of spinal cord injury

 

Pathology

 

Anterior column fails under compression

- hearing of the anterior vertebral body

- rupture of the ALL

- disruption of the discoligamentous complex

 

Posterior column fails under tension

- disruption of PLL

 

Retrolisthesis of upper spinal column

 

Xray / CT

 

Tear drop fractureTeardrop fracture 2

 

Large antero-inferior body fragment / tear drop

- > 20 %

- stays attached to  ALL

 

+/- posterior superior fragment retropulsed into canal

 

MRI

 

MRI teardrop fracture

Teardrop fracture with disruption of ALL with cord contusion and disc prolapse

 

DDx

 

Extension tear drop injury

- fragment much smaller

- stable injury

 

Management

 

Urgent reduction

- tongs

- GA

 

Anterior +/- posterior fixation

 

Fusion 1Fusion 2

 

Anterior posterior fixation 1Anterior posterior fixation 2

 

Results

 

Fisher et al Spine 2002

- HTB (24) versus anterior fixation (21)

- increased kyphosis in HTB patients

- five failures in HTB patients

 

Extension-distraction teardrop

 

Mechanism

 

Forced extension

 

Pathology

 

Antero-inferior avulsion fracture of the ALL

Stable in flexion

Not thought to be as severe as flexion-teardop

 

Epidemiology

 

Common with Ankylosing Spondylitis / DISH

 

Xray / CT

 

Usually thin fracture fragment

Widening of disc anteriorly

 

Extension Distraction CTExt Distraction MR

 

Stages

 

1. Anterior ligament failure

– disc space widening (or transverse fracture of vertebral body)

 

2. Posterior ligament failure

- retrolisthesis of superior vertebral body

 

Management

 

Anterior +/- posterior approach

 

Results

 

Chen et al Eur Spine J 2023

- meta-analysis of surgical approach for Ankylosing Spondylitis patients

- no signficant difference between anterior / posterior /combined