Neglected Hangman's fracture in association with rupture of the trachea

BACKGROUND CONTEXT: Rupture of the trachea combined with a Hangman's fracture has been reported rarely in the literature. We present a case of a rupture of the trachea combined with a type IV Hangman's fracture that remained undiagnosed for 7 weeks, in a 25-year-old woman after a road traffic accident. PURPOSE: To underline the necessity that physicians treating patients with multiple injuries including the trachea and the mediastinum should be aware of the fact that injuries of the trachea can be accompanied by trauma to other contents of the mediastinum and of the cervical spine. STUDY DESIGN: A 24-year-old woman was involved in a head on collision road traffic accident. She has suffered from a rupture of the trachea combined with a type IV Hangman's fracture that remained undiagnosed for 7 weeks. METHODS: Emergency surgical repair of the rupture of the trachea was performed. A halo vest for a total period of 4 months was applied. RESULTS: The patient followed a rehabilitation program, and, at her last visit, 12 months after her injury, had remained asymptomatic. A computed tomography scan of her cervical spine showed union through callous formation, and she had returned to her previous job and recreational activities. CONCLUSIONS: Physicians treating patients with multiple injuries including the trachea and the mediastinum should be aware of the fact that injuries of the trachea can be accompanied by trauma to other contents of the mediastinum and of the cervical spine. (C) 2008 Elsevier Inc. All rights reserved.