Hangman’s fracture presenting to chiropractic clinic as benign neck pain: a case report

Abstract

Objective: The purpose of this study is to report a patient who presented to a chiropractic clinic with benign neck and upper back pain; however, the patient also had a recent hangman's fracture due to a drunken fall. Clinical features: A 40-year-old established patient with neck and upper back pain presented to a chiropractic clinic for care. When questioned about the character and etiology of his pain, he reported that it was no different compared to past presentations, saying "it's the same as always." The patient was not questioned about recent trauma and did not report his fall while intoxicated several days prior. After history and examination, the working diagnosis was a low-grade cervical sprain strain with imaging considerations if improvement did not occur quickly as was observed with similar previous presentations. Treatment included chiropractic mobilization of the cervical spine. The following day, the patient reported no improvement. Upon additional questioning, a history of trauma was revealed; and plain radiographic imaging showed a C2 vertebral body fracture. Intervention and outcome: Immediate referral and evaluation at a local emergency center revealed not only an unstable C2 fracture but a coronal fracture of the left frontal bone extending into the left temporal bone with an associated right subdural hemorrhage along the right hemisphere and tentorium. The patient was placed in a sterno-occipital-mandibular immobilizer brace and discharged 2 days later. Conclusion: Historical experience with similar clinical presentations in established patients can influence health care providers to assume a benign causation of symptoms. Conscious effort must be exerted to treat established patients with typical presentations with the same diligence as those of new patients to a chiropractic clinic. This case illustrates that an unstable fracture and hematoma can present to a chiropractic clinic as a seemingly benign problem.