Spine: clay-shoveler fracture: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Spine: clay-shoveler fracture

Sample item

A labourer lifting a heavy load of wet earth feels a sudden sharp pain at the base of the neck, as if something snapped. There is no neurological deficit. A lateral radiograph shows a detached fragment at the tip of a lower cervical spinous process. What is the injury?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Spinous process avulsion of C7, a stable injury

The supraspinous and interspinous ligaments pull off the spinous process of C6, C7 or T1 during sudden muscle contraction against a heavy load. The injury is a stable avulsion and is treated symptomatically with a collar and analgesia.

Option by option

  • A. Fracture through the base of the dens of C2

    A dens base fracture is a C2 body-level injury seen after flexion or extension trauma.

  • B. Spinous process avulsion of C7, a stable injury (correct)

    Correct. Ligament pull on the spinous tip causes a stable avulsion of the lower cervical spinous process.

  • C. Ring fracture of C1 from axial loading

    A ring fracture of C1 follows axial compression, as in diving.

  • D. Bilateral pars fracture of C2, an unstable injury

    Pars fractures of C2 are hangman fractures from extension with distraction.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is B, Spinous process avulsion of C7, a stable injury. The supraspinous and interspinous ligaments pull off the spinous process of C6, C7 or T1 during sudden muscle contraction against a heavy load.

Why is "Fracture through the base of the dens of C2" not the answer?

A dens base fracture is a C2 body-level injury seen after flexion or extension trauma.

Why is "Ring fracture of C1 from axial loading" not the answer?

A ring fracture of C1 follows axial compression, as in diving.

Why is "Bilateral pars fracture of C2, an unstable injury" not the answer?

Pars fractures of C2 are hangman fractures from extension with distraction.

What concept does this question test?

It tests Spine: clay-shoveler fracture in Orthopaedics. The injury is a stable avulsion and is treated symptomatically with a collar and analgesia.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Spine: clay-shoveler fracture?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.