- Department of Neurosurgery, Airlangga University – Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia.
DOI:10.25259/SNI_666_2020Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Galih Indra Permana. Treatment of unusual hangman’s fracture in cluster region during coronavirus 2019 pandemic. 04-Dec-2020;11:415
How to cite this URL: Galih Indra Permana. Treatment of unusual hangman’s fracture in cluster region during coronavirus 2019 pandemic. 04-Dec-2020;11:415. Available from: https://surgicalneurologyint.com/surgicalint-articles/10430/
Background: Hangman’s fractures are one of the most frequent types of high cervical spine injuries. Here, we present a quadriplegic patient due to a hangman’s fracture treated during the coronavirus 2019 (COVID-19) pandemic.
Case Description: A 19-year-old male was quadriplegic and in spinal shock following a motor vehicle accident. X-rays showed a C2 hangman’s fracture with instability. X-rays and CT studies both confirmed anterior dislocation at C2 on C3 with bilateral pedicle C2 fractures and 5 mm of subluxation. In addition, he had an infiltrate in both lungs consistent with the diagnosis of COVID-19. The patient was intubated for respiratory failure and hemodynamically stabilized for his spinal shock. Unfortunately, before surgical intervention could be undertaken, the patient sustained a fatal cardiorespiratory arrest.
Conclusion: Utilizing appropriate personal protective equipment, it was and should be possible to treat patients with spinal injuries in the presence of active COVID infection. However, the risks of treating such spinal urgencies and emergencies should be thoroughly discussed with the entire nonsurgical and surgical treatment teams (e.g., including anesthesiologists, physicians, nurses, and other caregivers).
Keywords: Coronavirus 2019, Hangman’s fracture, Spinal shock, Spine surgery procedure
The coronavirus 2019 (COVID-19) pandemic poses unique nonsurgical and surgical treatment challenges to spinal surgeons in Surabaya, Indonesia (e.g., black zone). Initially, all elective spinal surgeries were cancelled, and only emergent operations were performed. Here, we share our experience regarding the impact of the COVID-19 pandemic on the treatment of a patient with an acute cervical hangman’s fracture in the presence of quadriplegia. We specifically focused on how all staff treating such spine-injured patients must utilize personal protective equipment (PPE).
A 19-year-old male sustained a motor bike accident. He presented with a loss of consciousness, difficulty breathing, and C3-level quadriplegia. X-rays and CT studies both confirmed anterior dislocation at C2 on C3 with bilateral pedicle C2 fractures and 5 mm of subluxation [
Hangman’s fractures, due to hyperextension-distraction injuries, are typically characterized by bilateral C2 pedicle fractures and dislocation/subluxation.[
A COVID-19-positive quadriplegic patient was diagnosed utilizing X-ray and CT as having a C2-C3 fracture/dislocation injury (e.g., hangman’s fracture) with hematomyelia. However, he expired before an MR and surgery could be performed. This case emphasizes the need to carefully screen/treat these patients, making sure that all medical staffs appropriately utilize full PPE.
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