title: Undetected hangman's fracture in a patient referred for physical therapy for the treatment of neck pain following trauma.
abstract: OBJECTIVE
  This case report describes a patient referred for physical therapy treatment of neck pain who had an underlying hangman's fracture that precluded physical therapy intervention.
  
  
  METHODS
  This case involved a 61-year-old man who had a sudden onset of neck pain after a motor vehicle accident 8 weeks before his initial physical therapy visit. Conventional radiographs of his cervical spine taken on the day of the accident did not reveal any abnormalities. Based on the findings at his initial physical therapy visit, the physical therapist ordered conventional radiographs of the cervical spine to rule out the possibility of an undetected fracture.
  
  
  RESULTS
  The radiographs revealed bilateral C2 pars interarticularis defects consistent with a hangman's fracture. The patient was referred to a neurosurgeon for immediate review. Based on a normal neurological examination, a relatively low level of pain, and the results of radiographic flexion and extension views of the cervical spine (which revealed no evidence of instability), the neurosurgeon recommended that the patient continue with nonsurgical management.
  
  
  CONCLUSIONS
  In patients with neck pain caused by trauma, physical therapists should be alert for the presence of cervical spine fractures. Even if the initial radiographs are negative for a fracture, additional diagnostic imaging may be necessary for a small number of patients, because they may have undetected injuries that would necessitate medical referral and preclude physical therapy intervention.
authors.affiliation: Department of Physical Therapy, David Grant US Air Force Medical Center, 124 Bradley Blvd, Travis AFB, CA 94535, USA. michael.ross2@travis.af.mil
authors.forename: Michael D
authors.initials: MD
authors.lastname: Ross
authors.forename: John M
authors.initials: JM
authors.lastname: Cheeks
mesh_terms: D002574:Cervical Vertebrae / Q000293:injuries*; D003951:Diagnostic Errors; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology* / Q000628:therapy; D026741:Physical Therapy Modalities; D012017:Referral and Consultation; D016103:Spinal Fractures / Q000150:complications / Q000175:diagnosis* / Q000628:therapy