Clay-shoveler's Fracture in a 13-year-old Child - Case Report and Review of Literature.

Abstract

Introduction: A clay-shoveler's fracture is a relatively uncommon stress-type avulsion fracture typically affecting the lower cervical or upper thoracic spinous processes. Historically named after clay shovelers due to their predisposition to such injuries, this type of fracture is now more frequently observed in individuals participating in sports activities that entail rotational movements of the upper spine.

Case report: A 13-year-old patient, while performing agricultural work and using a manual shovel to excavate an area, experienced cramping in the cervical spine, neck pain, and a significant limitation in the range of motion. The patient presented with a history and physical examination suggestive of a clay-shoveler's fracture. Subsequent X-ray images demonstrated an acute soft-tissue avulsion of the spinous process at C7. With non-operative therapy, the patient returned to work within 2 months, experiencing occasional, intermittent discomfort 6 months after the injury, which did not limit any activities. After 2 years of follow-up, the patient reported no pain.

Conclusion: A clay-shoveler's fracture is a rare stress-type avulsion fracture, particularly in children. Diagnosis necessitates clinical suspicion, a targeted history, and a thorough physical examination. Radiographs play a crucial role, and in challenging cases, magnetic resonance imaging may be warranted to detect soft-tissue avulsions. Treatment typically involves cervical immobilization of the cervical spine for 4-6 weeks.