Hangman's fracture
Background
- Also known as traumatic spondylolisthesis
- Is an unstable spine injury
- Bilateral C2 pedicle fracture (leads to C2 displacing anteriorly on C3)
Vertebral fractures and dislocations types
- Cervical fractures and dislocations
- Thoracic and lumbar fractures and dislocations
Clinical Features
- Seen in MVA, diving accidents, but uncommonly judicial hangings (not in suicidal hangings)[1]
- Forced extension of an already extended neck
- Spinal cord damage is often minimal (diameter of neural canal is greatest at C2)
Differential Diagnosis
Neck Trauma
- Penetrating neck trauma
- Blunt neck trauma
- Cervical injury
- Neurogenic shock
- Spinal cord injury
Evaluation
- Xray or CT cervical spine
Management
Prehospital Immobilization
Hospital
- C-collar
- Consult ortho or neurosurgery
- External fixation via rigid cervical orthosis or halo-vest orthosis 8-14 weeks (~90% healing with immobilization alone) [2]
- Surgical fixation, especially if there is:[3]
- Severe angulation of C2 on C3
- Disruption of C2 to C3 disc space
- Inability to establish or maintain alignment with external immobilization
- Nonunion after use of external immobilization
Disposition
- Admit
See Also
External Links
References
- ↑ James, R. and Nasmyth-Jones, R. (1992) ‘The occurrence of cervical fractures in victims of judicial hanging’, Forensic Science International, 54(1), pp. 81–91
- ↑ Coric D, Wilson JA, Kelly DL Jr. Treatment of traumatic spondylolisthesis of the axis with nonrigid immobilization: a review of 64 cases. J Neurosurg. 1996 Oct;85(4):550-4. doi: 10.3171/jns.1996.85.4.0550. Erratum in: J Neurosurg. 1996 Dec;85(6):1198. PMID: 8814154.
- ↑ Murphy H, Schroeder GD, Shi WJ, Kepler CK, Kurd MF, Fleischman AN, Kandziora F, Chapman JR, Benneker LM, Vaccaro AR. Management of Hangman's Fractures: A Systematic Review. J Orthop Trauma. 2017 Sep;31 Suppl 4:S90-S95. doi: 10.1097/BOT.0000000000000952. PMID: 28816880.
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