title: Clay-shoveler's fracture equivalent in children.
abstract: METHODS
  Case report and literature review.
  
  
  OBJECTIVE
  This article reports 2 cases of clay-shoveler's fracture equivalent in children presenting acutely after participation in sports.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  Retrospective review of 2 cases.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Children's Hospital Los Angeles, Children's Orthopaedic Center, Los Angeles, CA 90027, USA.
authors.forename: Kent T
authors.initials: KT
authors.lastname: Yamaguchi
authors.forename: Karen S
authors.initials: KS
authors.lastname: Myung
authors.forename: Manuel Aparicio
authors.initials: MA
authors.lastname: Alonso
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019547:Neck Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D011859:Radiography; D016103:Spinal Fractures / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology