C7 transverse process fracture12/27/2023 Nonunion of spinous process’s fracture seems to be the rule in so far as the displacement between the bone fragments is important. Because it may prove impossible to image the obliquely oriented spinous process in a single axial CT plane, sagittal reconstruction may provide additional information regarding vertebral segment alignment and permit assessment of interspinous distances, enhancing detection of distraction injuries associated with ligament tears. However this radiographic assessment is often limited, and cases of clinically suspected spinous process fracture often require CT evaluation, as in our case, to confirm diagnosis. The latter indicates a complex spinous process fracture with extension into the lamina and spinal canal. The conventional assessment of the cervico-thoracic posterior elements can reveal, on the AP view, a double spinous process sign and, on the lateral view, a fracture line and a spinolaminar breach. In the case reported here, the mechanism of injury most likely represented avulsion stress, associated with abrupt flexion and hyperextension of the cervical spine. The latter has been referred to as a clay-shovelers' fracture because, historically, it has represented an occupational risk in those workers. They have been reported secondary to trauma, surgery, neoplasm or stress fracture. Spinous process fractures represent avulsion injuries at the attachment of the interspinous, supraspinous and nuchal ligaments, most often reported at C7 and T1 level. To better show the superior and inferior alignment of the fracture fragments, sagittal computer-generated reconstruction of the fractured vertebral segments were also obtained (Figure 2). Malunion of C7, which heals on T1, nonunion of the spinous process of T1 and C6-C7 osteoarthritis were identified on CT (Figure 1). Because he complained of dorsal pain with a palpable crepitus and paravertebral muscle spasm, a cervicodorsal CT examination was performed. The patient came back within the framework of a medical expertise 5 years later. He received pain killers and a Minerva jacket was applied for one week. His hospital course was uneventful, and he was discharged four days after the admission. Computed Tomography (CT) studies were performed and confirmed fractures of the spinous process of C7 to T1 and of the posterior arch of the first right rib. Lateral films of the thoracic spine obtained in the emergency section were inadequate. Detailed neurological examination revealed no abnormality. No abrasion or bruising was present on the neck or the chest. Physical examination revealed tenderness over his upper thoracic spine. He was led to the emergency the same day with a complaint of pain in his upper back. The vehicle was not equipped with air bags. He was wearing a three-point belt and was not ejected from the car. A 39-year-old man was a front passenger of a car which crashed head-on into a wall at approximately 50 kmph.
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