Floating Fracture In College Football

HISTORY: 20-year-old male football athlete presents with acute anterolateral neck pain after a defensive play in the 4th quarter. While blocking, the athlete made direct helmet-to-helmet contact causing the chin strap to slide down and compress against the anterior neck. Subsequently, he reported tenderness over the neck with shortness of breath and odynophagia. Despite the topical analgesic gel, the patient continued to have pain. When patient's symptoms were not improving for 5 minutes after impact, he was evaluated by the airway team. The replay footage was reviewed. Due to mechanism of injury, the patient's care was escalated to the emergency room (ER) for further evaluation. Athlete was transported via ambulance with the athletic trainer to the ER. PHYSICAL EXAM: Tenderness to palpation over the sternocleidomastoid and submandibular region with limited range of motion due to pain reproduced with neck flexion, extension, and lateral bending to the right side. Patient maintained a patent airway and was conversational with clear speech and without dyspnea. Oropharynx was clear and patent. Vitals stable without neurologic symptoms. DIFFERENTIAL DIAGNOSES: 1. Strain of Sternocleidomastoid2. Tracheal Injury 3. Airway hematoma4. Hyoid fracture5. Blunt cerebrovascular injury RESULTS: CTA of Neck w/ contrast: No evidence of blunt vascular injury or hematoma.Nasolaryngoscopy: Negative for tracheal injury, but mild swelling around trachea (by ENT in the ER)Due to persistent neck pain, patient underwent a fine-cut CT Neck without contrast showed a small fracture of the right hyoid greater cornu (3D reconstruction) with some mild medial displacement.FINAL DIAGNOSIS: Right Hyoid Fracture at the Greater Cornu TREATMENT AND OUTCOMES: 1. Due to initial odynophagia, patient was on a soft diet for 3-7 days and progressed as tolerated2. Ibuprofen 400 mg was used as needed for pain control3. Progressed to a solid diet after week 14. Repeat visualization with nasolaryngoscopy 2 weeks post injury with improvement in swelling 5. Physical therapy involving neck isometric and dynamic exercises were started at week 6. Return to play contact football was as expected within 3 weeks from injury with the athlete having painless full range of motion, normal strength, and ability to meet the demands of his sport.