Hangman's fracture

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Initial posting from: Bernard Bendok, MD

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Hangman’s fracture refers to traumatic C2 spondylolisthesis with bilateral pars or pedicle fractures. This is often accompanied by subluxation of C2 on C3 and posterior or anterior longitudinal ligament injury. However, most patients remain neurologically intact and do not require surgical stabilization.

Classification

Type I: Stable pars fracture with ≤ 2mm of dislocation. Place patient in Philadelphia collar.

Type II: Unstable pars fracture with PLL +/- ALL disruption and avulsion of C2-C3 disk

Reduced with gentle traction

Type IIA: Involves greater angulation than Type II, but less displacement

Type III: C2-C3 facet capsules are disrupted, followed by pars fracture. Any reducible II, IIA, or III fracture requires Halo orthosis; otherwise anterior fusion with plating is necessary.

References

  1. Levine AM, Edwards CC: The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am 67: 217-226, 1985.
  2. Caspar W, Barbier DD, Klara PM. Anterior cervical fusion and Caspar plate stabilization for cervical trauma.Neurosurgery. 1989 Oct;25(4):491-502.
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