Hyoid Dislocation Following Subacute Fracture in an American High School Football Athlete

Derrick M. Knapik; Sarah J. Royan; Michael J. Salata; James E. Voos

摘要

Musculoskeletal injuries are exceedingly common in American football because of the contact-and-collision nature of the sport. More than 350,000 injuries are documented in the >1 million high school athletes participating in American football annually.~( 22 , 26 )Injuries to the neck are largely uncommon, composing only ～6% of the injury total; however, if they are not properly diagnosed and treated, they can lead to severe, potentially fatal consequences.~( 9 , 13 , 26 ) Lying in the anterior midline of the neck and well protected by the mandible superiorly, the cervical spine posteriorly, and thyroid cartilage anteriorly is the U-shaped hyoid bone.~( 5 )As the only bone in the body not articulating with any other bone,~( 12 )the hyoid functions to maintain patency of the pharynx for swallowing and respiration while serving as an attachment point for the middle pharynx.~( 18 )The hyoid is rarely susceptible to direct trauma, with fracture rates accounting for only 0.002% to 1% of all fractures and with dislocations being even less common.~( 5 , 6 , 27 )However, hyoid injuries with resultant bony penetration into the pharyngeal mucosa may compromise the patency of the airway, injure the external carotid artery, or cause infection.~( 2 , 12 , 24 ) The majority of documented hyoid injuries occur in victims of strangulation, hanging, or motor vehicle accidents.~( 4 , 6 , 12 , 17 , 23 )Reported hyoid fractures following sports-related trauma are exceedingly infrequent, with only 6 total cases documented in the literature: football (n = 2),~( 5 )basketball (n = 2),~( 6 , 17 )hockey (n = 1),~( 4 )and karate (n = 1).~( 21 )There are currently no reports of hyoid dislocation secondary to sport-related trauma. In this case report, we present a high school football player presenting with an acute hyoid dislocation in the setting of a subacute fracture sustained 6 weeks prior. Case Report Informed consent was obtained from the patient and parent for use of his information and imaging. The study was reviewed by our institution’s institutional review board and was deemed to not qualify as human subject research. The patient was a 15-year-old high school sophomore who sustained a direct blow to the anterior neck by the helmet of a teammate during contact drills at practice. At the time of injury, the patient was in full pads, with his appropriately fitted helmet in place and secured with a hard-shell chinstrap. Following the collision, he was able to stand and walk off the field with no loss of consciousness. He presented to the athletic trainer complaining of headache, throat pain, and amnesia to the event. During physical examination, the athletic trainer noted confusion, slowed speech, and right upper extremity weakness to the deltoid, infraspinatus, and subscapularis graded as 4 out of 5 strength on examination. The patient complained of odynophagia; however, no dysphonia or stridor were detected. Intense pain was elicited with palpation of the anterior aspect of the neck at the level of the thyroid cartilage, but no pain was elicited with cervical range of motion testing in all planes. Out of concern for concussion, throat pain, and weakness, he was advised to go to an emergency room for further examination. Following arrival to the emergency department 2 hours after injury, the patient continued to complain of throat pain, dizziness, and confusion. Vital signs were normal, and on physical examination, the neck was symmetric in appearance with no ecchymosis or cervical edema. On palpation, point tenderness was noted over the right upper midline of the neck at the level of the thyroid cartilage, although no crepitus, masses, or lymphadenopathy was present. The hyoid was mobile during swallowing, even though the player continued to report odynophagia. He also continued to demonstrate right upper extremity weakness to the shoulder, scored as 3 out of 5 strength by the emergency department physician. During examination, the player reported a similar injury 6 weeks prior, during a game in which he was tackled and the opponent’s helmet was driven into his upper chest, causing his hard-shell chinstrap to hit his throat. He reported having had minor difficulty breathing and odynophagia following the injury but was able to complete the game. He also reported having minor neck pain on palpation and odynophagia following the injury, which gradually resolved after 4 weeks. He did not cite this injury or symptoms to the athletic trainer, coach, or team physician, and he missed no games or practices. The athlete denied having any preceding neck trauma or possessing symptoms of odynophagia or difficulty breathing prior to this initial injury. For comfort, a soft cervical collar was placed in the emergency department. Computed tomography (CT) of the head and magnetic resonance imaging of the brain were performed out of concern for concussive symptoms (ie, confusion and slowed speech), and results revealed no abnormalities. Of note

机译：由于这项运动具有接触和碰撞的特性，因此在美式足球中，肌肉骨骼损伤极为普遍。每年参加美式足球的超过100万名高中运动员中，有35万多人受伤。〜（22，26）颈部受伤的情况很少见，仅占总伤害的6％。但是，如果不能正确诊断和治疗它们，则可能导致严重的潜在的致命后果。〜（9，13，26）躺在颈部的前中线，并受到下颌骨的良好保护，其颈椎位于颈椎的后部，〜（5）作为体内唯一不与任何其他骨骼铰接的骨骼，〜（12）舌骨的功能是维持咽部的吞咽和呼吸的通畅性，同时充当〜（18）舌骨很少受直接创伤的影响，骨折率仅占所有骨折的0.002％至1％，而脱位的发生率甚至更低。〜（5，6，27但是，由于舌骨样损伤导致骨渗透到咽粘膜中，可能会损害气道的通畅性，损伤颈外动脉或引起感染。〜（2，12，24）大多数文献记载的舌骨样损伤发生在绞窄的受害者中，韩，或汽车事故。〜（4，6，12，17，23）报道的与体育有关的创伤引起的舌骨骨折极少发生，文献中仅记录了6例：足球（n = 2），〜（ 5）篮球（n = 2），〜（6，17）曲棍球（n = 1），〜（4）和空手道（n = 1）。〜（21）目前尚无运动引起的舌骨脱位的报道-相关的创伤。在此病例报告中，我们介绍了一名高中足球运动员，在持续6周前发生的亚急性骨折中，出现急性舌骨脱位。病例报告获得患者和父母的知情同意，以使用他的信息和影像。该研究已由我们机构的机构审查委员会进行了审核，被认为不符合人体研究的资格。该患者是一名15岁的高中二年级学生，在练习中进行接触式训练时，他被队友的头盔直接击中前颈部。受伤时，患者穿着充分的防护垫，并戴好合适的头盔，并用硬壳下巴固定。碰撞后，他能够站立并走出场地，而不会失去知觉。他向运动教练提出抱怨该事件的头痛，喉咙痛和健忘症。在体格检查过程中，运动教练注意到对三角肌，下鼻肌和肩sub下肌的困惑，言语减慢和右上肢无力，评分为5分中的4分。患者主诉吞咽困难;但是，没有检测到声音障碍或喘鸣。在甲状腺软骨水平触及颈部的前侧会引起剧烈疼痛，但在所有平面上的颈椎运动测试范围都不会引起疼痛。由于担心脑震荡，喉咙疼痛和虚弱，建议他去急诊室做进一步检查。受伤2小时后到达急诊室后，患者继续抱怨喉咙疼痛，头晕和神志不清。生命体征正常，经身体检查，颈部对称，无瘀斑或宫颈水肿。触诊时，在颈部右上中线在甲状腺软骨水平上发现了点压痛，尽管没有出现cre，肿块或淋巴结肿大。即使玩家继续报告吞咽痛，舌骨在吞咽过程中仍可活动。他还继续表现出肩膀右上肢无力，被急诊科医师评为5分中的3分。在检查过程中，球员在6周前报告了类似的受伤情况，比赛中他被抓住，对手的头盔被撞到他的上胸部，导致他的硬壳chin带撞到了他的喉咙。他报告说受伤后呼吸和吞咽困难稍有困难，但能够完成比赛。他还报告说，受伤后触诊和吞咽痛有轻微的颈部疼痛，在4周后逐渐缓解。他没有向运动教练，教练或团队医师提到这种伤害或症状，并且他没有错过任何比赛或练习。运动员否认有任何先前的颈部外伤或在此初次受伤之前有吞咽困难或呼吸困难的症状。为了舒适起见，在急诊室放置了柔软的颈托。出于对脑震荡症状（即意识混乱和言语迟缓）的关注，进行了头部计算机断层扫描（CT）和大脑的磁共振成像，结果未发现异常。注意

Hyoid Dislocation Following Subacute Fracture in an American High School Football Athlete

摘要

著录项

相似文献

相关主题

期刊订阅