IS case 477: Clay shoveler's fracture

Narasimhachar Prativadi, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-08-30


Patient is a 25-year-old male who presented with neck injury after a horse racing accident.


Fracture of C7 with caudal displacement of fractured tip. AP view shows "ghost sign" appearance of two spinous processes at the level of the injury.


Clay shoveler's fracture is a vertical or oblique fracture of the C6 or C7 spinous process. It is a stable fracture and not associated with neurological damage. The name for this type of fracture comes from clay workers who would shovel sticky clay over their shoulders. Sometimes the clay would stick to the shovel causing the supraspinous ligaments to undergo tremendous force and avulse a spinous process. The fracture can best be seen on lateral cervical radiograph. On AP view, the well known "ghost sign" can be seen where a double spinous process can be seen due to the caudal displacement of the fractured portion of the spinous process.


  1. Greenspan A. Orthopedic Imaging: A Practical Approach, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2004.
  2. Brant WE, Helms CA, eds. Fundamentals of Diagnostic Radiology, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2007.
  3. Weissleder R, Wittenberg J, Harisinghani MG, et al. Primer of Diagnostic Imaging, 4th ed. Philadelphia: Mosby Elsevier, 2007.

2 images