Working Diagnosis:
Progressive, active C5 radiculopathy secondary to traumatic foraminal stenosis and disc herniation at C5-6 and fracture of C5 lamina and facet

Treatment:
The treatment was an Anterior Cervical Discectomy and Fusion of C5-C6. Case Photo #2

Outcome:
The patient was taken to surgery for repair of the C5 lamina fracture approximately three months following the initial incident. Following surgery and physical therapy, he made a full recovery and gained back full strength in his right upper extremity and radiculopathy symptoms resolved.

Author's Comments:
This patient's traumatic finger amputation unfortunately distracted from a C5 lamina fracture that remained untreated for approximately three months following the initial injury. The patient received immediate treatment for the injuries to his hand, but due to the distracting nature of the finger amputation and negative shoulder X-rays, the cervical spine fracture and disc herniation went undiagnosed for two months. This led to atrophy of the shoulder girdle muscles, right shoulder weakness, and persistent pain over several months. In hindsight, initial cervical spine X-rays performed alongside the right shoulder imaging due to neck and shoulder pain could have prompted further evaluation and timely diagnosis of the cervical spine fracture and disc herniation. This case highlights the risks associated with distracting injuries that may result in other injuries being overlooked. Fortunately, the patient's cervical fracture was eventually identified, treated appropriately, and he made a full recovery.

Editor's Comments:
An injury that is very painful or profound enough to divert a patient's or examiner's attention from other potentially more serious injuries is considered a distracting injury. In this case, the extreme tension of the rope generated enough force to amputate part of the finger and likely caused increased traction through the shoulder, resulting in a whiplash effect on the cervical spine. The patient's traumatic amputation diverted attention from his neck and shoulder pain, which was ultimately due to a C5 lamina fracture and disc herniation. Distracting injuries can occur in emergency situations and must not prevent a thorough trauma evaluation.

References:
Marcon RM, Cristante AF, Teixeira WJ, Narasaki DK, Oliveira RP, de Barros Filho TE. Fractures of the cervical spine. Clinics (Sao Paulo Brazil). 2013;68(11):1455-1461.

Sengupta DK. Neglected spinal injuries. Clin Orthop Relat Res. 2005;(431):93-103.

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