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The axial load teardrop fracture

A biomechanical, clinical, and roentgenographic analysis

Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania

Helene Pavlov, MD

Department of Radiology, The Hospital for Special Surgery, New York, New York

Mary Jane O'Neill, MD

Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania

Claude E. Nichols, III, MD

University of Vermont, Burlington, Vermont

Brian Sennett, MD

Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania

The anteroinferior cervical vertebral body corner frac ture was originally described by Schneider and Cann as the "teardrop" fracture. This report analyzes the biomechanical, clinical, and roentgenographic features of 55 such fractures obtained from the National Football Head and Neck Injury Registry. Teardrop fractures resulting from tackle football characteristically occurred in players attempting to make a tackle in which initial contact was made with the top or crown of the helmet. There were two fracture patterns associated with the anteroinferior corner (teardrop) fracture fragment: 1) the isolated fracture, which is usually not associated with permanent neurologic sequelae; and 2) the three- part, two-plane fracture in which there is an associated sagittal vertebral body fracture as well as fracture of the posterior neural arch. This latter pattern was almost always associated with permanent neurologic se quelae, specifically quadriplegia. Axial loading of the cervical spine was clearly identified as a mechanism of injury for both fracture patterns. Roentgenographic ex amination must include both anteroposterior and lateral views with computed tomography or tomography as necessary to determine the presence of the sagittal vertebral body fracture and the integrity of the posterior neural arch.

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