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

Vertebral anatomy.

Numbering order of vertebrae.

• Cervical fractures and dislocations
  • Atlanto-occipital dissociation
  • C1
    • Jefferson fracture
    • C1 isolated anterior arch fracture
    • C1 isolated posterior arch fracture
  • C2
    • Odontoid fracture
    • Hangman's fracture
  • C3-C7
    • Cervical burst fracture
    • Cervical spinous process fracture
    • Extension cervical teardrop fracture
    • Flexion cervical teardrop fracture
    • Anterior cervical wedge fracture
  • Cervical facet dislocation
  • Isolated transverse process fracture
• Thoracic and lumbar fractures and dislocations
  • Chance fracture
  • Thoracic burst fracture
  • Lumbar burst fracture
  • Isolated transverse process fracture
  • Thoracic and lumbar compression fractures

Clinical Features

Hangman's Fracture

• Seen in MVA, diving accidents, but uncommonly judicial hangings (not in suicidal hangings)
  • 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
  • Vertebral and carotid artery dissection
  • Strangulation
  • Whiplash injury
• Cervical injury
  • Cervical fractures and dislocations
  • Cervical injury (peds)
  • Cervical spine clearance
• Neurogenic shock
• Spinal cord injury

Evaluation

• Xray or CT cervical spine

Management

Prehospital Immobilization

See NAEMSP National Guidelines for Spinal Immobilization

Hospital

• C-collar
• Consult ortho or spine as needed

Disposition

• Admit

See Also

• Cervical spine injuries