Figure 1. Case courtesy of Dr Muhammad Asadullah Munir, From the case rID: 78890



This is a flexion teardrop fracture – the mechanism of injury is hyperflexion and axial compression. It is associated with anterior and posterior ligamentous tears, injury to the ligamentum flavum, and posterior subluxation. It is generally seen in C4-C6 [1].

  • Pearl: Four lines can be drawn to assist in reading cervical spine x-rays and CTs (Figure 2). These include the anterior vertebral, posterior vertebral, spinolaminar, and posterior spinous lines. Note that all four are disrupted in Figure 1.

Figure 2. Case courtesy of Dr Andrew Dixon, From the case rID: 32505

  • Pearl: Don’t confuse this with an extension teardrop fracture, which has fewer ligament tears and is considered less severe (Figure 3). It is generally seen in C2-C3.

Figure 3. Fracture at C2, note only the anterior line is disrupted. Case courtesy of Radswiki, From the case rID: 11268

Unstable. A common phrase used to remember unstable cervical fractures is “Jefferson Bit off a Hangman’s Thumb.” A brief description of each is as follows:

Jefferson FractureC1 burst fractureAxial Loading
Bilateral Facet DislocationVertebral body anterior translocationHyperflexion
Odontoid FractureC2 Dens (Zone II)Flexion or Extension
Atlanto-Occipital DislocationCranial dislocation from C1, i.e. decapitationFlexion or Extension
Hangman’s FractureC2 Pars InterarticularisHyperextension
Flexion Teardrop FractureC4-6Flexion

A flexion teardrop fracture is most commonly associated with anterior cord syndrome [1]. This syndrome presents as loss of movement and pain/temperature below the level of the lesion with preservation of the dorsal columns (vibration, proprioception, and 2-point discrimination).

The patient should be maintained in strict C-spine precautions with a properly fitted collar at all times. A spine surgeon should be emergently consulted as determined by institutional protocols.


Resources & References:

Check out ALiEM’s Paucis Verbis cards to brush up on other can’t miss adult neck and cervical spine injuries.

  1. Kim, Kwang S., et al. “Flexion teardrop fracture of the cervical spine: radiographic characteristics.” American Journal of Roentgenology 152.2 (1989): 319-326.
Mark Hopkins, MD

Mark Hopkins, MD

Loma Linda University Health
Mark Hopkins, MD

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William Denq, MD CAQ-SM

William Denq, MD CAQ-SM

Assistant Professor
Department of Emergency Medicine
University of Arizona
William Denq, MD CAQ-SM


Clinical Assistant Professor Emergency Medicine and Sports Medicine University of Arizona George Washington University '18 University of Pittsburgh '14 and '10