April 11, 2009

Hangman's Fracture

Fig. 1: Lateral view of a cervical spine radiograph of an 18-year-old woman who sustained a motor vehicle accident shows anterolisthesis of C2 over C3 (arrowhead) and fracture lines involving the C2 pars interarticulares. The anterior and posterior spinal lines are disrupted.
Fig. 2: Axial CT image of the cervical spine at C2 level shows fractures of bilateral C2 pars interarticulares. The fracture on the right extends to the transverse foramen where the right vertebral artery is located. The examination also demonstrates an abrupt narrowing of the right vertebral artery, consistent with dissection.

Hangman's Fracture
  • Traumatic spondylolisthesis of C2
  • Fractures of the lamina, articular facets, pedicles or pars interarticulares of C2 with disruption of C2-C3 junction
  • Common etiology: fall, diving, motor vehicle collision
  • Treatment options depend on the stability of the fracture. Stable injuries without neurological deficit and signs of later instability - usually require only immobilization for a period of time.

Look for:
  • If there is anterior translation of C2 over C3, if translation >3 mm with >10 degree angulation -- likely unstable
  • If there is dislocation of facet joints -- likely unstable
  • Other associated C-spine pathology (found in up to 1/3 of cases)

Li XF, Dai LY, Lu H, Chen XD. A systematic review of the management of hangman's fractures. Eur Spine J 2006;15:257-269.

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