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Clay Shoveler's Fracture
 17 yo male restrained

driver presents packaged
by EMS, involved in car vs
tree, head-on MVC at
approx 35-40 mph. No
LOC, no airbag
deployment, broken
windshield. Pt did
ambulate on scene. C/o
cervical neck pain.

 AFVSS

 Gen: WDWN, A&Ox4
 HEENT: NC/AT, PERRL,

TMs intact
 Neck: C6-C7 CMT without
step-offs, trachea midline.
 Neuro: CNs 2-12 intact, Nml
5/5 motor strength and
sensation x 4. Nml reflexes.
 MSK: No thoracic/lumbar
TTP/step-offs. No gross signs
of trauma. Long bones and
joints palpated without
tenderness or instability.
Clay Shoveler's Fracture
C6 spinous process fracture. No facet or laminar fracture seen
 Lateral C-spine radiograph, or CT
 Analgesics
 Philadelphia C-collar on discharge to be worn for at

least 10 days
 Early follow-up with Orthopedics, 1-2 weeks
 Non-operative management if fracture is isolated and
presence of instability has been ruled out
 Clay Shoveler’s Fracture is considered stable
 Caused by intense flexion against a contracted

posterior erector spinal muscle; MC due to
deceleration MVCs
 Most common at C7 > C6> T1
 If avulsion frx is not limited to spinous process but
extends into lamina, there is greater potential for
spinal cord injury
Clay Shoveler's Fracture
Illustration of Clay Shoveler’s Fx
and normal vertebral anatomy
 Schwartz DT: Emergency Radiology: Case Studies:

http://www.accessemergencymedicine.com
 Simon RR, Sherman SC: Emergency Orthopedics, 6th
ed. Chapter 9: Cervical Spine Trauma.
www.accessemergencymedicine.com
 Tintinalli’s Emergency Medicine: A Comprehensive
Study Guide, 7th ed. Chapter 255: Spine and Spinal
Cord Trauma
 http://radiopaedia.org/cases/barbell-injury-tocervical-spine-c6-clay-shoveler-fracture-1

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Clay Shoveler's Fracture

  • 2.  17 yo male restrained driver presents packaged by EMS, involved in car vs tree, head-on MVC at approx 35-40 mph. No LOC, no airbag deployment, broken windshield. Pt did ambulate on scene. C/o cervical neck pain.  AFVSS  Gen: WDWN, A&Ox4  HEENT: NC/AT, PERRL, TMs intact  Neck: C6-C7 CMT without step-offs, trachea midline.  Neuro: CNs 2-12 intact, Nml 5/5 motor strength and sensation x 4. Nml reflexes.  MSK: No thoracic/lumbar TTP/step-offs. No gross signs of trauma. Long bones and joints palpated without tenderness or instability.
  • 4. C6 spinous process fracture. No facet or laminar fracture seen
  • 5.  Lateral C-spine radiograph, or CT  Analgesics  Philadelphia C-collar on discharge to be worn for at least 10 days  Early follow-up with Orthopedics, 1-2 weeks  Non-operative management if fracture is isolated and presence of instability has been ruled out
  • 6.  Clay Shoveler’s Fracture is considered stable  Caused by intense flexion against a contracted posterior erector spinal muscle; MC due to deceleration MVCs  Most common at C7 > C6> T1  If avulsion frx is not limited to spinous process but extends into lamina, there is greater potential for spinal cord injury
  • 8. Illustration of Clay Shoveler’s Fx and normal vertebral anatomy
  • 9.  Schwartz DT: Emergency Radiology: Case Studies: http://www.accessemergencymedicine.com  Simon RR, Sherman SC: Emergency Orthopedics, 6th ed. Chapter 9: Cervical Spine Trauma. www.accessemergencymedicine.com  Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7th ed. Chapter 255: Spine and Spinal Cord Trauma  http://radiopaedia.org/cases/barbell-injury-tocervical-spine-c6-clay-shoveler-fracture-1