summary Extension Teardrop Fractures of the cervical spine are subaxial cervical spine fractures caused by forced extension of the neck with resulting avulsion of the anteroinferior corner of the vertebral body. Diagnosis can be made with lateral radiographs of the cervical spine. Treatment is usually immobilization in a hard collar as the injury is mechanically stable. Epidemiology Incidence rare Etiology Pathophysiology extension mechanism causes disruption of the anterior longitudinal ligament (ALL) represents a true avulsion often of an anterior osteophyte distinguish from a flexion teardrop fracture larger fragment produced by compression extension teardrop fractures are stable in flexion, and unstable in extension not considered as severe as flexion teardrop fractures Associated conditions central cord syndrome buckling of the ligamentum flavum into canal during hyperextension phase of injury risk factors elderly anterior osteophytes and posterior infolded ligamentum flavum can be seen in diving accidents not usually associated with spinal cord injuries Presentation Symptoms neck pain Physical exam patients are usually neurologically intact may have symptoms of central cord syndrome Imaging Radiographs recommend views AP and lateral of cervical spine findings avulsion fracture from attachment of the ALL to the inferior corner of the vertebral body usually a thin fracture fragment fragment is usually triangular in shape - reminiscent of a teardrop may see anterior disc space widening MRI may help distinguish extension injury from flexion injury edema will be located anteriorly in extension injury Treatment Nonoperative immobilization in hard collar indications most injuries