Clay-Shovelerʼs Fracture Equivalent in Children

Abstract

Case report and literature review. This article reports 2 cases of clay-shoveler's fracture equivalent in children presenting acutely after participation in sports. The clay-shoveler's fracture in adults is an avulsion fracture of the lower cervical or upper thoracic spinous process. To our knowledge, this is the first report in English literature on soft-tissue avulsion injury of the spinous process in children presenting with history and symptoms similar to clay-shoveler's fractures. Retrospective review of 2 cases. A 14-year-old baseball player and a 16-year-old wrestler experienced acute posterior neck pain after participation in sports. Both patients presented with a history and physical examination suggestive of clay-shoveler's fracture but showed no evidence of injury on radiographs. Subsequent magnetic resonance images demonstrated an acute soft-tissue avulsion of the spinous process at C7 in 1 patient and T2 in the other. With nonoperative therapy, both patients returned to sports by 4 months, with occasional, intermittent discomfort a year after injury, which did not limit any activities. In adolescents, if the history and physical examination are consistent with a clay-shoveler's fracture, but radiographs are normal, magnetic resonance imaging may be indicated to diagnose a soft-tissue avulsion.