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Spinous Process Fracture (avulsion frx – “Clay Shoveler’s Frx)

- Discussion:
    - type of hyperflexion avulsion injury - fx of spinous process at base;
    - they are caused by sudden exertions of the muscular attachments, and can be caused by flexion injuries;
    - most common at C7 > C6 > T1
    - considered stable;
    - if avulsion frx is not limited to spinous process but extends into lamina, there is greater potential for spinal cord injury;
    - be sure to rule out associated facet frx or unilateral jump facet;

- Treatment:
    - once presence of segmental instability has been ruled out, Clay shoveler's fractures can be treated non operatively;
    - hard collar should be worn for at least 10 days or until good flexion-extension views can be obtained;
          - afterwards, cervical collar is worn until good callus is present