Reduction and Open Fixation of a Cervical Teardrop Fracture: A Technical Note.

Abstract

Cervical teardrop fractures are hyperflexion and axial loading injuries associated with significant ligamentous disruption. Patients sustaining these types of injury are classically treated with a cervical corpectomy and anterior fusion. However, there are notable disadvantages of this approach, namely, disruption of the patient's true anatomic alignment and a reduction in the number of fixation points available for cervical fusion. Here we present a novel method of open reduction and internal fixation in a neurologically intact patient with cervical teardrop fracture. A 34-year-old man presented to Ryder Trauma Center after a helmeted motorcycle accident. The patient was found to be neurologically intact on arrival, and imaging demonstrated a C5 teardrop fracture without bony retropulsion. The patient was taken to the operating room for an open reduction and internal fixation of the fracture using a novel technique. This technique used traditional diskectomies at the C4-5 and C5-6 levels, along with a temporary, unicortical screw into the C5 body to capture the anteriorly displaced fragment. A bicortical screw was then placed into the contralateral side, and now, having fully reduced the fracture, the first (temporary) screw was replaced with a bicortical screw. The patient was neurologically intact postoperatively, with 2-month follow-up computed tomography scan demonstrating stable reduction of the fracture. Here we present a novel technique for open reduction and internal fixation of a cervical teardrop fracture that does not require cervical corpectomy. This technique is particularly useful in patients with an anteriorly displaced fragment and without neurologic deficit or compromise.