Clay Shoveler Fracture¶

Definition¶

A clay shoveler fracture is an avulsion fracture of a spinous process, most commonly involving C6, C7, or T1. The injury was originally described in Australian clay workers who sustained the fracture from the sudden muscular pull of the trapezius and rhomboid muscles on the spinous process during shoveling of heavy clay.

Mechanism of Injury¶

The classic mechanism involves sudden forceful flexion of the neck against contracted extensor muscles, or a direct blow to the spinous process. In the modern setting, clay shoveler fractures occur from:

Motor vehicle collisions (hyperflexion mechanism)
Sports injuries
Direct trauma to the posterior neck
Forceful muscular contraction (weightlifting, shoveling)

The supraspinous and interspinous ligaments transmit the distracting force to the spinous process, resulting in an avulsion fracture at the base or tip of the spinous process.

Imaging Findings¶

Radiography¶

Lateral view — A displaced spinous process fragment at the cervicothoracic junction, seen as a "double spinous process" sign. The avulsed fragment is typically displaced inferiorly.
The fracture may be difficult to identify on the lateral view if the cervicothoracic junction is not well visualized.

CT¶

Fracture line through the spinous process, best seen on sagittal and axial images
The fragment may be minimally displaced or displaced inferiorly
Important to evaluate the remainder of the cervical spine for additional injuries

Clinical Pearl

A clay shoveler fracture is a stable injury because it involves only the posterior column (specifically the spinous process) without involvement of the vertebral body, pedicles, laminae, or ligamentous complex. However, in the trauma setting, it should prompt careful evaluation of the rest of the spine — spinous process fractures can accompany more significant injuries such as flexion-distraction injuries or burst fractures.

Management¶

Clay shoveler fractures are stable injuries and are treated conservatively with analgesics, activity modification, and occasionally a cervical collar for comfort. Healing typically occurs within 4–6 weeks. No surgical treatment is needed for isolated clay shoveler fractures.

Key Points¶

Clay shoveler fracture is an avulsion fracture of the spinous process, most commonly at C6, C7, or T1
It is a stable, posterior column-only injury
The "double spinous process" sign on lateral radiograph is the classic finding
CT confirms the diagnosis and excludes associated injuries
Treatment is conservative with excellent prognosis
In the trauma setting, evaluate the rest of the spine for additional injuries

References¶

Posthuma de Boer J, van Wulfften Palthe AFY, Stadhouder A, Bloemers FW. The Clay Shoveler's Fracture: A Case Report and Review of the Literature. J Emerg Med. 2016;51(3):292-297. doi:10.1016/j.jemermed.2016.03.020. PMID: 27262733.
Cancelmo JJ Jr. Clay shoveler's fracture. A helpful diagnostic sign. Am J Roentgenol Radium Ther Nucl Med. 1972;115(3):540-543. doi:10.2214/ajr.115.3.540. PMID: 5038634.
Hoong WTJ, Kaliya-Perumal AK. Multiple Clay Shoveler's Fractures of the Thoracic Spine. Diagnostics (Basel). 2022;12(9):2190. doi:10.3390/diagnostics12092190. PMID: 36140592.
Altunrende ME, Ekin EE. Traumatic isolated spinous process fractures. Ulus Travma Acil Cerrahi Derg. 2025;31(4):394-398. doi:10.14744/tjtes.2025.20830. PMID: 40211632; PMCID: PMC12000981.
Han SR, Sohn MJ. Twelve Contiguous Spinous Process Fracture of Cervico-Thoracic Spine. Korean J Spine. 2014;11(3):212-213. doi:10.14245/kjs.2014.11.3.212. PMID: 25346773; PMCID: PMC4206959.
Lee H, Yoon E, Choi G, Lee S. Multiple episodes of golf-related isolated spinous process fractures (clay-shoveler's fracture) and its ten-year follow-up. Trauma Case Rep. 2023;47:100903. doi:10.1016/j.tcr.2023.100903. PMID: 37674772; PMCID: PMC10477732.
Gaillard F, et al. Clay-shoveler fracture. Radiopaedia.org. https://radiopaedia.org/articles/clay-shoveler-fracture-2