Treatment of unusual hangman’s fracture in cluster region during coronavirus 2019 pandemic

Abstract

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).