Triangular cervical vertebral body fractures: diagnostic significance

A common feature of many fractures of the cervical spine is a triangular fragment broken from some part of the vertebral body. The radiographs of 109 patients with cervical spine fractures having a triangular vertebral body fragment were reviewed. Thirteen patients had two triangular fragments, a total of 122 triangular fragments. Eighty-eight (72%) fractures involved the anterior-inferior corner of the vertebral body. Other triangular fractures occurred in anterior-superior (16%), posterior-inferior (11%), and posterior-superior (1%) corners. The position and origin of these fragments are related to the mechanism of fracture. Complete radiographic assessment including tomography and CT revealed that these triangular corner fractures had other associated injuries of the body and of the posterior elements, characteristic of each particular form of triangular fragment. A knowledge of these patterns of injury guides the radiographic evaluation when a triangular fracture is identified on the initial lateral radiograph. A systematic approach to the evaluation of cervical spine fractures based on these triangular fragments is suggested.
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