Hangman's fracture


  • 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.

Clinical Features

Hangman's Fracture
  • 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


  • Xray or CT cervical spine


Prehospital Immobilization


  • 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


  • Admit

See Also

External Links


  1. 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
  2. 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.
  3. 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.